P445 Patients with active perianal fistulas have a reduced physical health compared with Crohn’s patients without perianal fistulas

Abstract

Perianal fistulas are a common complication in patients with Crohn’s disease (CD). We compared illness perceptions, coping strategies, health-related quality of life and work productivity between CD patients without fistulas and CD patients with active perianal fistulas. CD patients with fistulas from our outpatient clinic (n = 151) were asked to complete questionnaires on health-related quality of life (SF-12 and sIBDQ), work/activity impairment (WPAI), illness perceptions (IPQ-R) and coping strategies (CORS). Patients with active fistulas, defined as self-reported fistula production, and who returned all the questionnaires, were included in this study. CD patients without perianal fistulising disease were selected from the JOINT cohort1 and used as a control group (n = 112). Crude differences in each questionnaire between the two groups were analysed using the Mann–Whitney U test. Linear regression models were used to stabilise adjusted associations correcting by gender, age at diagnosis, disease duration and the presence of a stoma. Our cohort included 30 patients with active perianal fistulas. All patients had a long IBD disease history. Mean duration of perianal fistulising disease was 149 (SD = 99) months. Baseline characteristics between the two groups were comparable, although patients with active perianal fistulas were more likely to have a stoma (Table 1). Physical health (PCS-12) scores for patients with active fistulas were significantly lower compared with patients without fistulas (adjusted β = −5.5; CI(95%) = −10.6 to −0.5, p = 0.032). No differences in the mental health scores (MCS-12) or sIBDQ were detected between the two groups. Patients with active fistulas had significantly more work impairment (median 0.20 vs. 0.10, p = 0.010). Furthermore, patients with active fistulas held more negative views concerning the effects of their illness on daily functioning (adjusted β = 0.78; CI(95%) = 0.28 to 1.27 (95% CI), p = 0.003). No differences were found in coping strategies between the two groups. Patients with active perianal fistulas have a lower physical health, experience more work impairment and perceived more illness consequences compared with CD patients without perianal fistulas, which is important for the gastroenterologist to consider when treating these patients. 1. van Erp SJ et al. Classifying back pain and peripheral joint complaints in inflammatory bowel disease patients: a prospective longitudinal follow-up study. J Crohns Colitis, 2016;10:166–175.