P2660 - Disease Severity and Treatment Response in Esophageal Crohn’s Disease

Andy Wu, MD¹, Claudia Ramos Rivers, MD¹, Filippos Koutroubakis, MD², Amir Ghaffari, MD³, Elyse Johnston, MD², Jeffrey M. Dueker, MD, MPH², Gong Tang, PhD⁴, Dmitriy Babichenko, PhD⁴, Annette Scierka Wilson, PhD⁴, Marc Schwartz, MD², David Binion, MD^2
1University of Pittsburgh Medical Center, Pittsburgh, PA; ²UPMC, Pittsburgh, PA; ³University of Pittsburgh School of Medicine, Pittsburgh, PA; ⁴University of Pittsburgh, Pittsburgh, PA

Introduction: Esophageal involvement in Crohn’s Disease (CD) is rare manifestation, with limited information regarding natural history and optimal treatment. We sought to review our institutional experience with esophageal CD patients comparing their disease characteristics with the overall CD cohort, including biomarkers of severity and treatment requirement.

Methods: We conducted a retrospective observational study of patients with CD and esophageal involvement using a prospective, consented inflammatory bowel disease registry maintained at a referral center. Patients with CD evaluated between 2009 and 2019 who had endoscopic and/or histopathologic evidence of esophageal involvement formed the study group.

Results: A total of 38 esophageal CD patients were identified and 2348 CD patients formed the control population. The majority of esophageal CD patients were female (79%), with an average age of 41. Laboratory markers of disease severity demonstrated higher rates of elevated erythrocyte sedimentation rate (p=0.0001), C-reactive protein (p=0.0001), antibodies against the yeast Saccharomyces cerevisiae (ASCA) (p=0.0008), monocytosis (p=0.0027), and IgG-4 subclass deficiency (p=0.0032) in the esophageal CD patients compared with CD controls, but no difference in rates of peripheral blood eosinophilia or elevated IgG4 subclass antibodies. Extraintestinal manifestations were more common in esophageal CD compared with CD controls (p=0.0042).









Esophageal CD patients had a higher treatment requirement for biologics compared with control CD patients (92% vs 55%; p=0.0001), with tumor necrosis factor alpha (TNF-α) inhibitors being the predominant first line choice. Two thirds of esophageal CD patients failed initial biologic, and required multiple subsequent biologic agents. The typical progression of biologic treatments involved attempts at alternative TNF-α agent prior to utilization of biologics outside of this class, with a majority using interleukin 12/23 antagonist (ustekinumab). In addition to biologics, proton pump inhibitors were used in 81% of the esophageal CD patients compared with 53% of the control CD cohort (p=0.0001).

Discussion: Esophageal involvement in CD occurs in < 2% of cases and is characterized by a high degree of underlying disease severity based on multiple laboratory and clinical biomarkers. Esophageal CD represents a relatively treatment resistant phenotype that often requires progression beyond first line anti-TNF biologic therapy.



Disclosures:


Andy Wu, MD¹, Claudia Ramos Rivers, MD¹, Filippos Koutroubakis, MD², Amir Ghaffari, MD³, Elyse Johnston, MD², Jeffrey M. Dueker, MD, MPH², Gong Tang, PhD⁴, Dmitriy Babichenko, PhD⁴, Annette Scierka Wilson, PhD⁴, Marc Schwartz, MD², David Binion, MD². P2660 - Disease Severity and Treatment Response in Esophageal Crohn’s Disease, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.