P326 PREFAB-study: PRediction tool for Early identification of patients at risk of Crohn's disease in perianal Fistulas and ABscesses: interim analysis of a prospective pilot study at a non-academic, IBD-expert centre in the Netherlands. (30th January 2023)

• Record Type: Journal Article
• Authors: Munster, L; de Groof, E J; van Dieren, S; Mundt, M W; D'Haens, G R A M; Bemelman, W A; Buskens, C J; van der Bilt, J D W
• Is Part Of: Journal of Crohn's and colitis. Volume 17(2023)Supplement 1
• Page Start: i465
• Page End: i465
• Publication Date: 2023-01-30
• Subjects: Inflammatory bowel diseases -- Periodicals; 616.344005
• DOI: 10.1093/ecco-jcc/jjac190.0456
• Languages: English
• ISSNs: 1873-9946

Abstract

Abstract: Background: Perianal abscesses (PAA) and perianal fistulas (PAF) are life impairing conditions associated with Crohn's disease (CD). A retrospective study at Flevohospital showed a reduced median delay in diagnosis of CD from 33 months (IQR 23-64) in the period 2007-2016 to 3 months (IQR 0-5) in the period 2017-2021, with <20% of patients diagnosed <1 year after the first perianal surgical procedure in 2007-2016 versus 79% in 2017-2021. This study also showed CD in up to 10% of patients with PAA/PAF, which was reason to continue data collection in a larger prospective pilot study to identify risk factors for CD in patients presenting with PAA/PAF. Methods: All consecutive patients ≥16 years presenting with PAA/PAF were included. Patients were prospectively screened for risk factors/red flags from a 'perianal Red Flag Index Questionnaire' (pRFI) (identified from previous literature searches/expert opinion) and fecal calprotectin (FC-)samples were taken in all patients. Colonoscopy was performed in case of ≥5 positive answers in the pRFI and/or FC-values ≥150mcg/g. Results: Sixty-nine patients were included (72, 5% male) with median age of 41 years (IQR 30, 5-54, 6). Thirty-five patients (50, 7%) presented with PAA, whereas 34 patients presented with PAF (49, 3%). Thirty-one patients (44, 9%) had recurrent PAA/PAF. Additional colonoscopy was performed in 11 patients, in whom 5 patients (7, 2%) eventually were diagnosed with CD with a median delay of 44 months (IQR 7, 5-87, 5, still 5 patients in diagnostic work-up). Median FC-values were 552mcg/g (IQR 198, 5-4585) in patients with confirmed CD and 31, 5mcg/g (IQR 10-102, 75) in patients without CD (p=0, 002). Risk factors associated with CD were a younger age, presence of PAF (compared to PAA only), higher number of previous perianal interventions, multiple internal fistula openings, fissures and proctitis (p<0, 05 in all). Conclusion: This pilot study reveals several risk factors associated with CD in patients presenting with PAA/PAF and forms the basis for development of a clinical decision tool that incorporates both the pRFI questionnaire and selected FC-measurement to early identify patients at risk of CD when presenting with perianal disease. This clinical decision tool will be subject of a larger prospective multicentre study to reduce diagnostic/treatment delay, thereby improving outcomes in patients with Crohn's fistulas.