Abstracts
1998 Digestive Disease Week

#994

CLINICAL SUBTYPES OF CROHN'S DISEASE ACCORDING TO SURGICAL OUTCOME. S. E. Greenway, M. A. Buckmire, R. H. Rolandelli: Allegheny University of the Health Sciences, Philadelphia, PA.

A classification proposed for patients with Crohn's disease (CD) consists of two groups, perforator and non-perforator. The perforator group presents with acute perforation, fistulae, and abscess formation. The non-perforator group presents with stricture, obstruction, or unresponsiveness to medical therapy. In addition, up to one third of patients with CD present with perianal disease. Our purpose was to investigate whether patients who present with perianal disease constitute a separate group of CD in respect to surgical outcome. Ninety-one patients underwent 232 operations for CD. Following each surgery, patients were classified into one of three groups: perforator, non-perforator, and perianal disease, based on operative findings. Perforating complications presented with the highest Crohn's Disease Activity Index (CDAI), followed by non-perforators and then patients with perianal disease (p < 0.02). The perianal disease group had the most rapid rate of post-operative recurrence (p < 0.02) and subsequent surgery (p < 0.05), followed next by the perforator group and then the non-perforator group. Recurrence rate and subsequent operation intervals for the perforator group appeared to lengthen from 1.7 +/- 2.2 years and 2.3 +/- 2.2 years respectively, when treated post-operatively with Amino-salicylic acid (ASA) and/or antimicrobials, to 5.8 +/- 5.7 years and 6.4 +/- 7.5 years when treated with steroids and/or immunosuppressants. Recurrence rate and subsequent operation intervals for the non-perforator group were significantly lengthened from 3.8 +/- 4.4 years and 3.8 +/- 4.0 years respectively, when treated post-operatively with steroids and/or immunosuppressants, to 11.7 +/- 6.4 years (p < 0.01) and 12.9 +/- 6.8 years (p < 0.005) when treated with ASA and/or antimicrobials. Recurrence rate and subsequent surgery interval for the perianal disease group increased from 2.0 +/- 1.8 years and 2.9 +/- 1.7 years respectively, when treated with steroids and/or immunosuppressants, to 2.8 +/- 2.7 years and 3.5 +/- 3.3 years when treated post-operatively with ASA and/or antimicrobials. Our data suggests that perianal disease, as a form of CD, has independent predictive value, although not accurately reflected by the CDAI. In addition, patients operated on for perforating complications respond better to post-operative treatment with steroids and/or immuno-suppressants. Whereas, CD patients operated on for non-perforating and perianal disease complications better respond to treatment with ASA and/or antimicrobials post-operatively.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.