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P053. Is there a change in the natural history of Crohn's disease; Surgical rates and medical management in a population-based inception cohort from Western Hungary between 1977–2008

P.L. Lakatos1, G. David2, T. Pandur2, Z. Erdelyi2, G. Mester3, M. Balogh3, I. Szipocs4, C. Molnar5, E. Komaromi6, L.S. Kiss1, L. Lakatos2

1Semmelweis University, Budapest, Hungary; 2Csolnoky F. Province Hospital, Veszprem, Hungary; 3Grof Eszterhazy Hospital, Papa, Hungary; 4Municipal Hospital, Tapolca, Hungary; 5Magyar Imre Hospital, Ajka, Hungary; 6Municipal Hospital, Varpalota, Hungary

Aim: Several factors may be associated with the need for surgery, including disease phenotype and medical therapy. Our aim was to analyze the evolution of the surgical rates and medical therapy in the population-based Veszprem province database, which included incident patients diagnosed between January 1, 1977 and December 31, 2008.

Materials and Methods: Data of 506 incident CD patients were analysed age-at-diagnosis: 31.5 SD 13.8 years). Both hospital and outpatient records were collected and comprehensively reviewed. The study population was divided into three groups by year of diagnosis (cohort A: 1977–1989, cohort B: 1990–1999 and cohort C: 2000–2008).

Results: Overall azathioprine, systemic steroid and biological (available only after 1998) exposure was 45.8%, 68.6% and 9.5. The one- and 5-year probability of AZA use were 3.2% and 6.2% in cohort A, 11.4% and 29.9% in cohort B and 34.8% and 46.2% in cohort C. In a Kaplan–Meier and multivariate Cox-regression analysis decade of diagnosis (p < 0.001), age at onset (p = 0.008), disease behavior at diagnosis (p < 0.001) and need for systemic steroids (p < 0.001) were significantly associated with the time to initiation of AZA therapy. Similarly, Kaplan–Meier analysis showed a significant reduction in the cumulative probability of intestinal surgery in Cohort C (pLogRank = 0.022). In a multivariate Cox analysis disease behavior at diagnosis (p < 0.001), AZA therapy before surgery (p < 0.001), and disease location (p < 0.001), but not decade of diagnosis and perianal disease were significant predictors for time to intestinal surgery in CD patients.

Conclusion: This population-based inception cohort has shown that recent reduction of surgical rates was independently associated with increased and earlier azathioprine use.