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Master Thesis

Facteurs prédictifs d’un nouvel épisode de suppuration après mise en rémission d’une maladie de Crohn ano-périnéale fistulisante

Abstract : Background: fistulising ano-perineal lesions occur in more than 20% of patients with Crohn's disease (CD). Although many medical and surgical treatments are now available, the relapse rate of such injuries remains high at nearly 30%. The objective of this study was to identify the predictors of a new episode of anal suppuration in patients with fistulising ano-perineal CD initially in remission. Methods: this is a monocentric retrospective study that included between 2007 and 2015 all patients with CD complicated with an anorectal fistula put into remission. The achievement of remission was defined by the absence of new suppuration within 3 months after the last drainage surgery. Patient characteristics were collected at drainage, at 3 months, which corresponded to the date of inclusion and during follow-up (point-date : 31/12/2017). The event studied during the follow-up was the occurrence of a new ano-perineal suppuration episode in relation to a fistula of CD proved by an examination under general anesthesia or on an MRI. Results: one hundred and fifty-seven patients (57% female, 35-year median age at drainage) were included consecutively during the period. The median duration of follow-up was 187.1 weeks (IQR 111.9-276.1). The rate of ano-perineal new suppuration was 22%, which occurred within a median time of 1.8 years. In actuarial, survival without suppuration was 96.7% at one year, 78.4% at 3 years and 74.4% at 5 years. In the 120 (76.4%) patients receiving anti-TNF therapy (84 infliximab and 36 adalimumab) after drainage, colonic (OR 1.25, p 0.015) or ileocolic (OR 5.16, p 0.015) localization of the CD, stenosing luminal phenotype (OR 5.32, p 0.013) and discontinuation of anti-TNF therapy during follow-up (OR 3.37, p 0.049) were associated with increased risk of new suppuration episode in multivariate analysis. In contrast, the discontinuation of immunosuppressive therapy was associated with a reduced risk of new episode of suppuration (OR 0.22, p 0.29). Neither the type of anti-TNF started nor the use of combotherapy were predictive of evolution. Conclusions: after effective drainage, survival with no new ano-perineal suppuration with CD is high, about 75% at 5 years. Associated colic involvement, stenosing phenotype and discontinuation of anti-TNF therapy are associated with a higher risk of new suppurative episode.
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Master Thesis
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Audrey Malian. Facteurs prédictifs d’un nouvel épisode de suppuration après mise en rémission d’une maladie de Crohn ano-périnéale fistulisante. Médecine humaine et pathologie. 2018. ⟨dumas-02093176⟩

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