P1574 - Clinical Presentation and Outcomes of Patients With Mid-Small Bowel Crohn’s Disease From a Large Referral Center Cohort

Adil Ghafoor, MD¹, Shivanand Bomman, MD², Danielle La Selva, BS¹, Troy Zehr, BS¹, Christopher Gault, MD, PhD¹, James Lord, MD, PhD¹, Elisa Boden, MD¹, Timothy Zisman, MD, MPH¹, Michael Chiorean, MD^3
1Digestive Diseases Institute, Virginia Mason Clinic, Seattle, WA; ²Virginia Mason Medical Center, Seattle, WA; ³Swedish Medical Center, Seattle, WA

Introduction: Introduction: A minority of Crohn’s disease (CD) patients have small bowel involvement (L4) outside the reach of standard endoscopy, hence being more challenging to diagnose and treat. We aimed to determine the clinical presentation, disease behavior and treatment outcomes in a large cohort of patients with mid-small bowel CD (MSBCD).

Methods: Methods: Patients with MSBCD were identified by chart review from a large, single-center IBD database. To be included, patients had to have SB involvement proximal to the terminal ileum (10 cm from the IC valve) and distal to the duodenum. Demographics, clinical presentation, disease phenotype and behavior were compared between cases and a control group of CD patients (3:1) matched for age and date of evaluation. We also assessed treatment outcomes in the MSBCD cohort.

Results: Results: 62 patients with MSBCD were identified from the database over a period from 2012-2019 (46.8% males, mean age 48.9 ± 20.6 years). Of these, 48.4% had exclusive MSBCD and were diagnosed via deep enteroscopy. The most common presenting symptoms were abdominal pain (83.1%), anemia (56.7%), small-bowel obstruction (51.7%), diarrhea (40%) and weight loss (38.3%). Compared with controls, MSBCD patients were more likely to be older at diagnosis, (mean age 48.9 vs 40.7; p = 0.004), have stricturing phenotype (B2) (82.3% vs 41.6%; p = < 0.0001), and less likely to have fistulizing disease (B3, 8.1% vs 27.4%, p = 0.087) including perianal disease (8.1% vs 26.2%; p = 0.007). The majority were treated with IMM (71.7%), and 71.7% with biologics (52.8% anti-TNF). Clinical response was achieved in 76.2% of MSBCD although 44.2% ultimately required surgical intervention at a median follow-up of 17 months.

Discussion: Discussion: Patients with MSBCD may represent a unique phenotype with more frequent stricturing disease and anemia as presenting symptoms, and older age at diagnosis. Although the response to medical treatment is within the range seen with other phenotypes, surgery is frequently required likely due to the late diagnosis. Identifying strategies for earlier diagnosis and monitoring of MSBCD patients is imperative.


Disclosures:
Adil Ghafoor indicated no relevant financial relationships.
Shivanand Bomman indicated no relevant financial relationships.
Danielle La Selva indicated no relevant financial relationships.
Troy Zehr indicated no relevant financial relationships.
Christopher Gault indicated no relevant financial relationships.
James Lord indicated no relevant financial relationships.
Elisa Boden indicated no relevant financial relationships.
Timothy Zisman indicated no relevant financial relationships.
Michael Chiorean indicated no relevant financial relationships.


Adil Ghafoor, MD¹, Shivanand Bomman, MD², Danielle La Selva, BS¹, Troy Zehr, BS¹, Christopher Gault, MD, PhD¹, James Lord, MD, PhD¹, Elisa Boden, MD¹, Timothy Zisman, MD, MPH¹, Michael Chiorean, MD³. P1574 - Clinical Presentation and Outcomes of Patients With Mid-Small Bowel Crohn’s Disease From a Large Referral Center Cohort, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.