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P112. The natural history of Crohn's disease (CD): A long-term (>10 years) follow-up study

F. Casals-Seoane1, J.P. Gisbert1, M. Chaparro1

1Hospital Universitario de La Princesa, IP, Gastroenterology and CIBEREHD, Madrid, Spain

Background: Most of the studies on the natural history of CD include small cohorts with less than 5 years of follow-up.

Aims: To study the natural history of CD in a cohort with more than 10 years of evolution. To identify predictive factors of bad outcome.

Methods: A retrospective study including CD patients with more than 10 years of evolution was performed. The study population was divided into 3 groups by year of diagnosis (Group A = 1985–1991, Group B = 1992–1997, Group C = 1998–2001). Survival curves were compared with the Kaplan–Meier test. Cox regression analysis was performed to identify predictive factors of surgery in these patients.

Results: 133 patients with CD were included. Mean follow-up was 17 years (range 3–51). 29% presented changes in disease behaviour. At baseline, the proportion of patients with stricturing behaviour was 11%, while 9% had penetrating behaviour. At the end of follow-up, these figures were 23% and 24% respectively. 43% of these changes occurred within the first 5 years of follow-up. There was an increasing and earlier use of thiopurines over time: 10 years after diagnosis the proportion of patients on thiopurines was 40% in group A, 59% in group B, and 82% in group C (p < 0.001), and the median time to start of thiopurines was 130, 83 and 39 months respectively.

Kaplan–Meier curve showing time from diagnosis to start of thiopurines by year of diagnosis.

Cumulative probability of intestinal surgery showed a small reduction over time: at 5 years after diagnosis it was 36% in group A, 28% in group B, and 25% in group C. 10 years after diagnosis these percentages were 47%, 41% and 35% respectively. Diagnosis between 1985 and 1991 (HR = 3.1; 95%CI = 1.5–6.3, p < 0.01), stricturing behaviour (HR = 3.7; 95%CI = 1.6–8.3, p < 0.001), penetrating behaviour (HR = 9.3; 95%CI = 4.1–20.8, p < 0.001) and perianal disease (HR = 2.9; 95%CI = 1.6–5.2, p < 0.001) were all associated with a higher risk of intestinal surgery.

Conclusions: In a significant proportion of patients, CD modified its behaviour to more severe forms during the follow-up. Overall and early use of thiopurines have markedly increased over the past 15 years. Stricturing or penetrating behaviour, diagnosis between 1985–1991 and perianal disease increased the risk of intestinal surgery.