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Clinical Gastroenterology
IDDF2023-ABS-0146 Disease and treatment factors influencing outcomes in fistulising crohn’s disease
  1. Jack McNamara1,
  2. Jane Mary Andrews2,
  3. Susan Jane Connor3,
  4. Joseph Louis Pipicella4,
  5. William Wilson5
  1. 1Ingham Institute for Applied Medical Research, Gastroenterology and Hepatology, Liverpool, New South Wales, Australia
  2. 2Central Adelaide Local Health Network, Adelaide, South Australia, Australia
  3. 3Liverpool Hospital, Department of Gastroenterology and Hepatology, Liverpool, New South Wales, Australia, Australia
  4. 4Lyell McEwin Hospital, North Adelaide Local Health District, Adelaide, South Australia, Australia

Abstract

Background Fistulising Crohn’s Disease (fCD) affects up to 40% of people with Crohn’s disease (CD) over their lifetime. Despite its prevalence, the burden of disease, treatment and ‘natural history’ is poorly described. This study explored demographics, disease and treatment factors in a real-world cohort.

Methods A registry created from deidentified data entered during routine care was interrogated in December 2022. People with CD and a care encounter in the last 14 months were included. The current fistula was defined as those with an actively draining fistula on the most recent radiologic, endoscopic or clinical assessment.

Results There were 3039 people with CD with a mean age of 43.1 and a mean disease duration of 13.7 years. Current or previous fCD was seen in 220 & 312 people. Current or previous fCD cohorts were younger than those without fCD (mean age 40.50, 39.63 & 44.1 years, p=0.0038 & p<0.0001). Male gender was more common in those with current (58%, p=0.022) or previous fCD (58%, p=0.007) compared to those without (50%).

Current and previous fCD cohorts had higher rates of current biologic use compared to those without fCD (75.5%, 68.3% & 48.9%, p<0.001 & p<0.001). People with current or previous fistula were more likely on anti-TNF therapy (Adalimumab or Infliximab) compared to those without fCD (85.5%, 82.2% & 68.1%; p<0.001 & p<0.001).

People with current or previous fCD had higher hospital admission rates for CD-related complications compared to those without fCD (5%, 6% & 1.9%, p<0.001 & p=<0.001). The previous fCD cohort had higher rates of CD-related surgery within the last year compared to people without fCD (21.2% vs 13.3%, p<0.001). People with active or previous fCD were less likely to have been on steroid therapy compared to those without fCD (23.2%, 24.4% & 32.3%, p<0.001 & p<0.001).

Conclusions People with current and previous fCD continue to experience higher hospitalisation rates for disease-related complications and more frequently require surgical procedures. This highlights the importance of further research into care gaps to improve outcomes and provide support for people with fCD.

https://doi.org/10.1136/gutjnl-2023-IDDF.194

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