P320. Factors determining therapeutic strategy at diagnosis and evolution of disease severity in a cohort of Belgian pediatric Crohn's disease patients (BELCRO)
E. De Greef1, J. Mahachie2, I. Hofman3, F. Smets4, S. Van Biervliet5, M. Scaillon6, B. Hauser1, P. Alliet7, W. Arts8, O. Dewit9, H. Peeters10, F. Baert11, G. D'Haens12, J.‑F. Rahier13, I. Etienne14, O. Bauraind15, A. Van Gossum16, S. Vermeire17, F. Fontaine18, V. Muls19, E. Louis20, F. Van de Mierop21, J.‑C. Coche22, K. Van Steen23, G. Veereman1
1UZ Brussels, Brussels, Belgium; 2Montefiore Institute, ULG, Liège, Belgium; 3University Hospital Gasthuisberg, Leuven, Belgium; 4UCL St Luc, Brussels, Belgium; 5UZ Gent, Ghent, Belgium; 6Hôpital des Enfants Reine Fabiola, Brussels, Belgium; 7Jessa Hospital, Hasselt, Belgium; 8ZOL, Genk, Belgium; 9Cliniques Universitaires St-Luc, Department of Gastroenterology, Brussels, Belgium; 10Ghent University Hospital, Department of Gastroenterology, Ghent, Belgium; 11Heilig Hartziekenhuis, Roeselare, Belgium; 12Academic Medical Center, Gastroenterology and Endoscopy, Amsterdam, Netherlands; 13Cliniques Universitaires UCL Mont Godinne, Yvoir, Belgium; 14CHR De La Citadelle, Liège, Belgium; 15Clinique St Pierre, Ottignies, Belgium; 16Hôpital Erasme, Department of Gastroenterology, Brussels, Belgium; 17University Hospital Gasthuisberg, Department of Gastroenterology, Leuven, Belgium; 18Clinique St. Joseph, Department of Gastroenterology, Liège, Belgium; 19CHU St-Pierre, Gastroenterology, Brussels, Belgium; 20University of Liège and CHU Liège, Department of Gastroenterology, Liège, Belgium; 21Hospital Sint Augustinusziekenhuis, Department of Gastroenterology, Wilrijk, Belgium; 22Clinique Saint Pierre, Corroy Le Grand, Belgium; 23Montefiore Institute, System and Modeling Unit, Liège, Belgium
Background: To determine associations between variables at diagnosis and disease severity at inclusion in the BELCRO database.
Methods: Data from previously diagnosed pediatric Crohn's disease patients were retrospectively evaluated at inclusion in the BELCRO database (current visit). Disease severity scores (PCDAI and PGA) were compared to initial treatment. Non-parametric association tests and multinomial logistic regression tests were used.
Results: Data on 152/156 patients were available with a median follow-up 2.4 yrs (range 0.1–7.9 yrs). Severe disease persisted in patients with L1 and L3 at diagnosis (p = 0.042 and 0.033). Patients with initial steroid treatment had a less active disease (p = 0.004). The need for surgery was only influenced by disease behavior (S) (p = 0.001), not by disease severity, location or treatment. No influence of treatment on BMI evolution was noticed. A positive family history was the only factor influencing treatment choice for 5‑ASA and immunomodulators (p = 0.02 and p = 0.004), except for L1 patients receiving less steroids (p = 0.039). During follow-up, there was a significant decrease in the use of steroids and 5‑ASA (p = 0.001; p = 0.001) and a significant increase in prescription of immunomodulators (p = 0.031). This parallels a significant decrease in the disease severity of this group of patients over time (p = 0.01).
Conclusions: L1 and L3 at diagnosis persist in more severe disease. More patients treated with corticosteroids at diagnosis achieved remission after a mean of 2.4 yrs follow-up. Family history appears to have been be the sole determinant for therapeutic strategy in this group.