P008 - Adalimumab sustains quality-of-life improvements in patients with Crohn's disease: 3-year data from CHARM

Abstract

A C). Four of them (57%) had fistula associated CRC. They suffered from CD for a median of 13 years (range 12 33). Seven patients with CRC were matched 1:3 to randomly selected Crohn’s patients based on age (9 male, 12 female). The medical records of these patients were evaluated with respect to duration and pattern of intestinal involvement of CD, fistula history, intestinal surgery, perianal surgery, prior immunosuppressive and 5-ASA derivative intake. Three patients of the matched group had involvement of the terminal ileum, 13 of ileocolon, 1 of upper GI and 4 of ileocolon and upper GI tract, with a disease duration of a median of 26 years (range 5 62). From these 21 patients 11 suffered from perianal fistula (52%). Results: Colorectal cancer was significantly (p = 0.048) associated with longstanding anorectal fistula (median = 11 years, range 0 28) in the CRC group compared to the matched Crohn’s patients [median = 1 year (range 0 6)]. The formation of cancer in a fistula showed a significant (p = 0.08) correlation with duration of the perianal disease. Earlier colonic surgery seemed to protect from later malignancy (p = 0.036; 16 matched controls had colonic surgery versus 2 patients in the CRCgroup). No significant symptoms preceded rectal carcinoma, except for new blood drainage from fistula in 2 patients. Two patients underwent ileocolonoscopy within 1 year before the diagnosis of malignancy without hint of dysplasia or carcinoma and 2 patients underwent MRI of the pelvic region within 4 months before surgery without recognizing malignant changes. There were no significant differences in 5-ASA, azathioprine intake or infliximab therapy, perianal surgery, extension and duration of the Crohn’s disease in both groups. The one year survival rate was 84% in patients with CRC. Conclusion: Colorectal carcinoma is generally rare in patients with Crohn’s disease, but is frequently associated with the presence of longstanding (>10 years of duration) anorectal fistula. It occurred with minimal change of symptoms and was not visible in previous MRI.