P821 Incidence of paediatric stricturing duodenal Crohn’s disease in South-East Scotland: A 12-year population-based cohort study

Abstract

Objectives and Study: Stricturing duodenal Crohn's disease (CD) is a rare but serious presentation of CD causing significant morbidity. There are no data on its incidence rate in paediatric CD, and only estimates for adult CD. Our aim is to provide the first incidence data and case studies outlining this severe presentation in children. Method(s): A regional cohort of prospectively acquired incident cases of PIBD diagnosed less than 16 years of age in paediatric services within a strict geographical area of South-East Scotland (based on postcode) was captured over a 12-year period (10.2005-09.2017). Incidence rates for all CD and for duodenal stricturing CD were calculated and standardised for age and sex with the Scottish Census of 2011. A retrospective review was conducted on the medical records of patients presenting with stricturing duodenal CD together with a detailed review of the available literature and consensus guidelines. Result(s): In total 157 new cases of paediatric CD (< 16yrs) were diagnosed within the study period. Median (IQR) age at diagnosis 13.1 (10.7-14.4) years; 64% male predominance. Overall CD incidence rate 5.80/100,000/year (95% CI 4.91-6.76) in South-East Scottish children, with a specific duodenal B2 phenotype disease incidence rate of 0.07/100,000/year (95% CI 0.01-0.27); representing 1.3% of incident cases at diagnosis. The two incident cases of stricturing duodenal CD (male aged 13.4yrs and female aged 15.5yrs) presented with typical systemic symptoms of weight loss, abdominal pain, anorexia and lethargy, together with recurrent vomiting suggestive of obstruction. Both cases partially responded to intensive and rapidly escalated medical therapy but eventually required surgery (laparoscopic gastroduodenostomy without resection). A detailed literature search confirmed there are no paediatric guidelines or case-reports relating to duodenal stricture as either a presentation or complication of CD. Conclusion(s): Duodenal stricture is a rare but serious presentation of CD causing significant morbidity and not currently covered in the paediatric literature or consensus guidelines. Best practice medical and surgical management remain uncertain and require further research.