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P311. Clinical presentation and risk factors for surgery in Crohn's disease: Analysis of 173 patients in China

X. Song

The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

Aim: To assess the clinical presentation and potential risk factors for initial surgery in patients with Crohn's disease in a Chinese population.

Methods: Data on clinical presentation and initial surgery were evaluated retrospectively in our hospital between 2000 and 2009. The influence of risk factors was assessed using multivariable logistic regression analysis.

Results: A total of 173 patients including 114 males and 59 females entered the study and the mean age at diagnosis was 31.5±13.3 years. Abdominal pain (90.8%), weight loss (59.0%), and diarrhea (58.4%) were the most common clinical presentations. A total of 85 patients (49.1%) eventually required surgery. Penetrating disease (B3) and stricturing disease (B2) had a significantly higher operation rate (83.9% and. 67.4% respectively). The risk of initial surgery was higher in male (OR = 2.02, 95% CI = 1.04–3.92) and those who were older than 40 years at diagnosis (OR = 2.34, 95%CI = 1.05–5.22). However, in patients with solitary colonic involvement, the risk of initial surgery was lower (OR = 0.35, 95%CI = 0.13–0.97).

Conclusions: Abdominal pain is the most common clinical presentation of Crohn's disease. Male is associated with a higher incidence and surgery rate than female. There are significant association between disease behavior and operation. Older than 40 years at diagnosis and male gender are significant risk factor for surgery while solitary colonic involvement is a protective factor.

Table 1. The clinical data of 173 CD patients
VariableNon-operative group n (%)Operative group n (%)P
Age (years)
A1 (≤16)11 (68.6)5 (31.4)0.133
A2 (17–40)65 (52.8)58 (47.2)0.414
A3 (>40)12 (35.3)22 (64.7)0.043*
Male/female52/36 (144.4)62/23 (269.6)0.055*
Symptoms
Abdominal pain78 (49.7)79 (50.3)0.329
Diarrhea55 (54.5)46 (45.5)0.303
Bloody stools34 (58.6)24 (41.4)0.147
Fever24 (48.0)26 (52.0)0.631
Anemia21 (42.0)29 (58.0)0.137
Weight loss53 (52.0)49 (48.0)0.730
Perianal lesions17 (50.0)17 (50.0)0.910
Extra-intestinal manifestationsa16 (43.2)21 (56.8)0.295
Site
L115 (55.6)12 (44.4)0.596
L216 (72.7)6 (27.3)0.028*
L336 (50.7)35 (49.3)0.971
L46 (40.0)9 (60.0)0.378
L1+L43 (37.5)5 (62.5)0.439
L2+L41 (25.0)3 (75)0.295
L3+L411 (42.3)15 (57.7)0.344
aExtra-intestinal manifestations including arthrosis, eyes, skin, oral cavity, hepatobiliary and other part lesion. *p < 0.1.
Table 2. Disease behavior of 173 CD patients
Typen (%)Non-operative group, n (%)Operative group, n (%)P-value
B152 (30.1)45 (86.5)7 (13.5)<0.001*
B243 (24.9)14 (32.6)29 (67.4)0.006*
B331 (17.9)5 (16.1)26 (83.9)<0.001*
B1p10 (5.8)8 (80)2 (20%)0.058
B2p8 (4.6)5 (62.5)3 (37.5)0.500
B3p29 (16.8)11 (37.9)18 (62.1)0.127
*p < 0.05.
Table 3. Relative risk for surgery in Crohn's disease
VariablesOdds Ratio95% Confidence Interval (CI)P
Male2.021.04–3.920.038
A32.341.05–5.220.039
L20.350.13–0.970.043