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P154. First diagnostic endoscopy does not predict disease course except stenosis, while smoking predisposes patients to severe endoscopic relapse in Crohn's disease

K. Gecse1, K. Farkas1, T. Kiss1, T. Nyari2, Z. Szepes1, F. Nagy1, T. Wittmann1, T. Molnár1

1University of Szeged, First Department of Internal Medicine, Szeged, Hungary; 2University of Szeged, Department of Medical Informatics, Szeged, Hungary

Background: Endoscopy is essential for the diagnosis, management and the prognostic evaluation of Crohn's disease (CD). The aim of this study was to evaluate (i) whether the initial diagnostic endoscopic activity predicts the outcome of CD as well as the need for surgery and (ii) whether the initial endoscopic activity correlates with the development of complications.

Methods: The medical records and endoscopic findings of 201 CD patients who underwent diagnostic colonoscopy between 2000 and 2005 were assessed. Demographic data, endoscopic findings, extraintestinal manifestations, perianal lesions, medical and surgical treatments were recorded in our prospective database; the mean time of patient follow up was 6.5 years. The evaluation of endoscopic activity was based on the Simplified Endoscopic Activity Score for Crohn's Disease (SES-CD). Chi-square test and logistic regression were used for statistical analyses.

Results: 533 endoscopies were performed in 201 patients with CD. The mean value of SES-CD at the first colonoscopy was 9.15. Endoscopic relapse occurred in 66 patients, of which 25 had been smoking at the time of diagnosis and 13 pursued smoking afterwards. Severe stenosis or deep ulceration was revealed in 24 and 47 patients at the first, diagnostic colonoscopy. Of the 65 patients with severe endoscopic activity (SES-CD), 18 showed endoscopic relapse during the follow up. 20% of the patients underwent ileal resection, 22.9% needed colectomy and surgeries of abscesses and fistulae were performed in 18.4% and 15.4% of the cases, respectively. Statistically, smoking was shown to be a risk factor for endoscopic relapse (p = 0.04). Initial SES-CD values did not correlate with the need for surgical interventions. Severe stenosis at the diagnostic colonoscopy predisposed to ileal (p = 0.05) or colonic (p = 0.0002) surgeries during the course of the disease. None of the examined further factors were in association with endoscopic relapse.

Conclusions: Our results did not reveal association between initial SES-CD values and disease outcome, however, severe stenosis predisposed patients to surgery. Considering demographic data, disease-specific parameters, extraintestinal complications, steroid, immunosuppressive and biological therapy, smoking was the only factor predicting severe endoscopic relapse. Our results confirm that achieving smoking cessation is a crucial goal of therapy in CD.