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P257. Available medical therapies do not affect development of major complications and need for surgery in Crohn's disease: Long-term prospective study on a population of 193 consecutive patients

E. Angelucci1, M. Cesarini1, P. Gentile2, S. Necozione2, G. Frieri2, R. Caprilli1, G. Latella2

1University of Rome, Rome, Italy; 2University of L'Aquila, L'Aquila, Italy

Introduction: Natural history of Crohn's disease (CD) is considered to be the result of the interaction between genetic and enviromental factors, disease's behavior and medical therapies. Aim of this study is to prospectically evaluate the effect of demographic and clinical characteristics of patients, as well as medical therapies on development of stricturing and penetrating disease complications and need for surgery.

Subjects and Methods: 193 consecutive pts (114M, 79F) prospectically evaluated. Mean follow up: 59 mo (range 12–120). Pts were classified according to the Vienna criteria. Clinical features and medical and surgical treatments performed during the follow-up period were assessed. Statistical analysis: Chi-squared test, Kaplan Meier survival method and Cox proportional hazards regression model.

Results: Of the 193 patients, 11.9% had diagnosis of CD at surgery for acute abdomen. Disease localization remains stable during the follow up. Disease behaviour showed striking changes: inflammatory non complicating disease decreased from 57% (at diagnosis) to 39% (at end of follow up), whereas stricturing and penetrating complications increased from 43% to 58%. Young age (<40 years) at diagnosis was the only independent risk factor of developing major disease complications (HR 5.02, CI 1.7–14.3). Cumulative probability of developing stricturing and penetrating complications was not affected by medical therapies. Overall, 30% of patients received intestinal resection after diagnosis. Number of relapses per year, stricturing and penetrating behaviour were independent risk factor for surgery during follow up (HR 5.9, CI 3.1–11.3; HR 4.3, CI 1.5–11.6; HR 4.9 CI 1.6–15.1, respectively). Cumulative probability of course free from surgery was significantly lower for patients with stricturing and penetrating pattern and for those receiving antibiotics (Figure 1).

Conclusions: CD behaviour changes over the course of the disease, whereas localization of the lesions remains stable. Number of flares and stricturing and penetrating pattern of the disease are risk factors for surgery in the long term. None of the available medical therapies influences the risk both of development of major complications and need for surgery.

Figure 1. Cumulative probability of a course free from surgery in relation to diseases behaviour.