Tu1225 Upper Gastrointestinal Tract Involvement in Crohn's Disease Requiring Anti-TNF Therapy: Clinical Characteristics

Abstract

Crohn's disease of the upper GI tract has been reported to be associated with more severe disease compared to lower GI involvement alone. Aim: To determine the clinical features of patients (pts) with Crohn's disease with upper GI tract involvement with severe disease as indicated by the need for anti-TNF alpha therapy. Methods: The medical records of pts with upper GI tract Crohn's disease seen at a tertiary care center between January 1, 1999 and December 31, 2009 were reviewed and those treated with an anti-TNF biologic were included. Results: We confirmed 410 patients with Crohn's disease with upper GI tract involvement including 33 treated with biologics (infliximab 22; adalimumab 5; multiple biologics 5; certolizumab pegol 1). There were 21 females (64%). Median age was 33 years (range, 12-62). Five pts had a family history of IBD. Six pts were current smokers at the start of biologic therapy. Upper GI symptoms were predominant in only 9 pts (28%) and 7 of the 9 pts (78%) had symptom relief with biologic treatment. One pt had gastric Crohn's disease without distal involvement; 30 pts also had ileal and/or colonic disease and two pts had perianal disease without ileal or colonic disease. Altogether, sixteen pts (48%) had perianal disease. Granulomas were identified in 10 pts (30%). Seventeen pts (52%) had previous surgery for Crohn's disease. A total of ten pts had a complete clinical response, 10 pts had a partial clinical response, and 13 pts had no response. Ten pts (30%) had severe adverse reactions to biologics requiring discontinuation of therapy, including: dermatitis 3; infections 2; delayed hypersensitivity reactions 2; anaphylaxis 1; oral lesions 1; and congestive heart failure 1. Conclusions: Lower GI symptoms are the usual indications for biologic therapy in pts with UGI tract Crohn's disease. Only one pt had isolated upper GI tract Crohn's disease. Granulomas were found in about a third of patients with UGI Crohn's treated with biologics. Nearly half of patients with upper GI Crohn's disease requiring biologics had perianal disease. Most patients with symptomatic upper GI Crohn's disease improved with biologic therapy, but more than one out of four pts had severe complications from therapy.