P431. Microscopic severity is related to earlier surgery in newly diagnosed CD patients: results from the DELTA cohort
V. Nuij1, C. Looman2, M. Rijk3, R. Beukers4, R. Ouwendijk5, R. Quispel6, A. van Tilburg7, T. Tang8, H. Smalbraak9, K. Bruin10, F. Lindenburg11, L. Peyrin-Biroulet12, C.J. van der Woude13, 1Erasmus Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands, 2Erasmus Medical Center, Public Health, Rotterdam, Netherlands, 3Amphia Hospital, Gastroenterology & Hepatology, Breda, Netherlands, 4Albert Schweitzer Hospital, Gastroenterology & Hepatology, Dordrecht, Netherlands, 5Ikazia Hospital, Gastroenterology & Hepatology, Rotterdam, Netherlands, 6Reinier de Graaf Hospital, Gastroenterology and Hepatology, Delft, Netherlands, 7Sint Franciscus Gasthuis, Gastroenterology & Hepatology, Rotterdam, Netherlands, 8IJsselland Hospital, Gastroenterology & Hepatology, Capelle aan den IJssel, Netherlands, 9Lievensberg Hospital, Internal Medicine, Bergen op Zoom, Netherlands, 10Tweesteden Hospital, Gastroenterology & Hepatology, Tilburg, Netherlands, 11Franciscus Hospital, Gastroenterology and Hepatology, Roosendaal, Netherlands, 12Nancy University Hospital, Université de Lorraine, Gastroenterology and Hepatology, Vandoeuvre-les-Nancy, France, 13Erasmus Medical Center, Department of Gastroenterology & Hepatology, Rotterdam, Netherlands
Background
Approximately 25% of Crohn's Disease (CD) patients undergo surgery within 5 yrs after diagnosis, despite using anti-TNF. We aimed to find factors related to time to surgery and the numbers of surgeries in newly diagnosed CD patients.
Methods
201 CD patients newly diagnosed in 2006 from the DELTA cohort were included. All clinical characteristics, IBD-related medications, endoscopy, pathology, radiology and surgical reports were collected. At diagnosis, 78 (38.8%) CD patients were suffering from ileocolitis; in eight patients (4.0%) the upper gastro-intestinal tract was involved and in 19 CD (9.5%) patients suffered from perianal disease. A Cox-regression model was used to assess factors associated with time to surgery and to determine a causal relation between anti-TNF and time to CD surgery. End of follow-up was 1 January 2012.
Results
The median length of follow-up was 40.11 months (range 0.2–47.9). Forty-seven patients (23.4%) underwent 75 IBD-related surgical procedures, 36 (48%) of which resections. Of the resections, 17 (47.2%) were ileocecal resections, ten (27.8%) colon resections and four (11.1%) small bowel resections. A more severe microscopic disease severity was associated with a shorter time to resection (p = 0.031), but not with time to any therapy start, whereas a more severe endoscopic disease severity was associated with time to therapy start (steroids p = 0.01, immunosuppressives p = 0.008, anti-TNF p = 0.03) but not with time to resection. Sixty-six patients started anti-TNF during follow-up of which 44 within 18 months after diagnosis. A propensity score matched Cox-regression model, showed a trend (p = 0.093, HR 0.473, CI 0.19–1.17) towards anti-TNF users having a longer time to surgery, compared to non anti-TNF users.
Conclusion
Microscopic disease severity is related to earlier surgery. Besides this, there seems to be a trend towards anti-TNF being protective for having early surgery.