P0917 Clinical, Endoscopic, Radiologic, and Therapeutic Profile of Perianal Crohn’s Disease: Insights from a Real-World Indian Cohort (iGONDOMAR-India study group)

Abstract Background Data on Perianal fistulizing disease, the most debilitating phenotype of Crohn`s disease (CD) from LMICs like India, remain limited despite the rising burden of disease. Methods Patients with diagnosed perianal fistulizing Crohn’s disease (CD-PF) were enrolled from 14 Indian centers. Patients with cryptoglandular fistula, fistula with unclear etiology and fistula with tuberculosis were excluded. Clinical characteristics, imaging, fistula characteristics, management strategies (antibiotics, immunomodulators, biologics, seton placement) and need for surgical interventions were studied. Results A total of 192 CD-PF patients (median age 33 years, 58.3% males) were included. The median duration of fistula was 42 (21-75) months and the median time to diagnosis of CD from the onset of fistula was 6 (0-24) months. Simple fistula was seen in 35% cases while complex fistula was seen in 65%. The most common type of fistula was inter-sphincteric (n = 93, 51.9%) followed by trans-sphincteric fistula (n = 59, 33%) on MRI pelvis. Anal strictures were seen in 9.7% (n = 17) while proctitis was seen in 65.5% (n = 118). Collections were documented in 57.9% of patients (n = 103). Among medical management, antibiotics were administered to most patients (87.5%), with 118/168 (70.2%) achieving a reduction in drainage and 45/168 (26.8%) achieving no drainage. Biologicals were used in 149/192 (77.6%) patients. Among 126 receiving infliximab, 93.6% received it as the first biologic & 69% received concomitant thiopurines. Median interval from fistula onset to infliximab initiation was 8 months (IQR 1–28). Among 111 patients with follow-up, complete healing occurred in 50 (45.0%), partial healing in 46 (41.4%), and no response in 15 (13.5%). Infliximab, Adalimumab, Vedolizumab, and Ustekinumab have been used as second/third-line agents in 8, 14, 7, and 20 patients. Multimodal therapy within 3 months of diagnosis was seen in 38/144 (26.3%) patients. Surgical management included seton placement in 63/192 (32.8%; median 2 setons), fistulotomy in 19 (9.9%), and fistulectomy in 37 (19.3%). Seton removal was done in 33 patients at a median of 31.5 (12-60) weeks. Diversion stoma and proctectomy were required in 11.4% and 1.6% of patients, respectively. Conclusion Perianal Crohn’s disease in this large Indian cohort was characterized by extensive colonic involvement, high rates of proctitis, and complex fistula patterns on MRI with a diagnostic delay of 6 months., Multimodal therapy was implemented only in 1/4th of cases. Comparison with other international CD-PF cohorts to harmonise data is planned. Conflict of interest: Dr. Jena, Anuraag: No conflict of interest Nagarajan, Kayal Vizhi: No conflict of interest Giri, Suprabhat: No conflict of interest Josy, Kiran: No conflict of interest Narang, Himanshu: None Bhardwaj, Arshia: No conflict of interest Singh, Arshdeep: None Midha, Vandana: No conflict of interest Kakkar, Chandan: No conflict of interest Venigalla, Pratap Mouli: No conflict of interest Shetty, Shiran: No conflict of interest Chandnani, Sanjay: No conflict of interest Kulkarni, Akshay: No conflict of interest Birda, Chhagan Lal: I declare no conflicts of interest Agarwal, Ashish: No conflict of interest Kedia, Saurabh: No conflict of interest Batra, Gitika: No conflict of interest Patil, Saee: No conflict of interest Panigrahi, Manas Kumar: No conflict of interest Nayak, Hemant Kumar: No conflict of interest Pati, Girish Kumar: No conflict of interest Narayan, Jimmy: No conflict of interest Bhat, Naresh: No conflict of interest Philip, Mathew: No conflict of interest Desai, Devendra C.: Nil Sood, Ajit: No conflict of interest Ahuja, Vineet: Nil Sharma, Vishal: None Sebastian, Shaji: Grant: Takeda, Tillots pharma, Biogen, Pfizer, Abbvie, Johnson & Johnson, Olympus -Odin Vision Personal Fees: Tillots, Johnson & Johnson, Olympus Odin Vision, AbbVie, Takeda, Merck, Pharmacosmos, Amgen, Eli Lilly, BMS, Odin Vision Non-financial Support: Tillots, Takeda, AbbVie, Celltrion, Johnson & Johnson, Eli Lilly, Alphasigma, Ferring Pharma