P1255Ano-Perineal Involvement in Moroccan Crohn’s Disease: Prevalence, Risk Factors, and Therapeutic Implications

Background Ano-perineal disease (APD) is a severe complication of Crohn’s disease (CD), associated with complex management needs. Data on its prevalence and predictors in North African populations are limited. Methods We analyzed 415 CD patients from a Moroccan IBD cohort (2016–2023). APD was defined by a positive Montréal perianal modifier (p) or documented ano-perineal lesions. Factors assessed included demographics, environmental exposures (smoking, appendectomy, family history), extraintestinal manifestations (EIMs), Montréal behaviour (B) and location (L), and treatment exposures (immunosuppressants, methotrexate, anti-TNF, ustekinumab) and surgery. Associations were tested using Chi² analysis. Results • Prevalence: APD was present in 25.1% of CD patients. • Environmental and demographic factors: No significant association with sex (p = 0.392), age (p = 0.411), smoking (p = 0.181), appendectomy (p = 0.164), or family history of IBD (p = 0.168). • EIMs: No significant association (p = 0.481). • Montréal classification: o Behaviour (B): not statistically significant (p = 0.126), though APD tended to be more common in penetrating (B3) disease. o Location (L): significant association (p = 0.036), with higher APD prevalence in L2 (colonic) and L3 (ileocolonic) involvement. • Treatment and surgery: o Anti-TNF therapy: more frequent in APD patients (significant, p = 0.0003). o Surgery: significantly more common in APD (35% vs lower in non-APD, p = 0.0205). o No significant differences for immunosuppressants (p = 0.232), methotrexate (p = 0.940), or ustekinumab (p = 0.794). Conclusion In this Moroccan cohort, one in four CD patients had ano-perineal involvement. APD was not linked to classic environmental factors or EIMs, but was significantly associated with certain disease locations and with greater need for anti-TNF therapy and surgery. These findings underline the importance of early identification and multidisciplinary management of APD to reduce morbidity. Conflict of interest: Naciri, Fatine: No conflict of interest Elmqaddem, Ouiam: No conflict of interest Koulali, Hajar: No conflict of interest Zazour, Abdelkrim: No conflict of interest Ismaili, Zahi: No conflict of interest Kharrasse, Ghizlane: No conflict of interest