P-072 YI Complex Perianal Disease With out Evidence of Luminal Crohn’s Disease

Perianal Crohn’s disease can predate the onset of intestinal inflammation by several years in about 5 to 10% of patients. There is evidence for the efficacy of biologic therapy in patients with known luminal Crohn’s disease and perianal fistulas but no published data on the use of these agents in patients with complex fistulas without evidence of luminal inflammation. To retrospectively describe a series of patients presenting with complex perianal fistulas without evidence of luminal Crohn’s disease and with no other identifiable cause. To document the response to therapy and begin to identify patient factors that may be more likely to result in therapeutic response. Patients with complex perianal disease without evidence of luminal Crohn’s disease were identified from 3 IBD gastroenterology practices at the Ottawa Hospital. A retrospective chart review was conducted. Data collected included patient demographics, type of fistula, smoking history, family history of IBD, Prometheus panel results (if available), and duration of perianal disease. If patients were treated medically, response to therapy was documented. Twenty patients with complex perianal or enterocutaneous fistulas were identified (Table 1). Prometheus panel was performed for 9 patients (4 had no IBD specific marker present, 2 had IBD specific p- ANCA present, 1 patient had both anti- Saccharomyces cerevisiae and Omp C present and 2 patients results are pending). Interestingly, only 1 patient with an IBD specific marker present (IBD specific p-ANCA) responded to biologic therapy. Of the 7 patients that were treated with a biologic agent (6 IFX, 1ADA), 1 patient went into remission (defined as closure of the fistula for at least 4 weeks), 3 responded (defined as closure of at least 50% of the fistulas present at baseline for at least 4 weeks), 2 had no response and for 1 patient it was too early to comment on their response to therapy. Of those treated with a biologic agent, 4 were females (3 responded) and 3 were males (1 remission). Of the patients who went into remission or responded, none were current smokers. Patients with response or remission to biologic therapy tended to have more complex fistulas (3 transsphincteric fistulas and 1 enterocutaneous/rectovaginal fistula). This series suggests that there may be a role for biologic agents in patients with complex perianal disease without evidence of luminal disease. Identifying patients who are likely to respond remains a challenge. In this patient population, patients with more complex fistulas and non-smokers appear to have a more favorable response. Larger prospective studies are needed to guide patient selection for these therapies. We are currently extending this study to include a case control arm.

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