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P159. Predictors of complicated disease in Crohn's disease and ulcerative colitis

E. Hoefkens1, M. Ferrante2, T. Bessissow2, I. Cleynen1, P. Rutgeerts2, G. Van Assche2, S. Vermeire2

1KULeuven, Department of Pathophysiology, Leuven, Belgium; 2University Hospital Gasthuisberg, Department of Gastroenterology, Leuven, Belgium

Background: Several clinical risk factors for a more complicated disease course of Crohn's disease (CD) and ulcerative colitis (UC) have been identified. We aimed to validate these factors prospectively in newly diagnosed CD and UC patients.

Methods: In total, 179 patients were followed for a median (IQR) of 32 (17–46) months. CD and UC were diagnosed in 104 and 79 patients, respectively (54% male, median age 26 years). At diagnosis, 36% of CD patients had ileal (L1), 11% colon (L2) and 53% ileocolonic involvement (L3) and 66% had inflammatory (B1), 16% stricturing (B2) and 18% fistulizing behavior (B3), 34% were active smoking and 83% had elevated C‑reactive protein level (CRP >5 mg/L). In UC, 27% had proctitis (E1), 21% left-sided (E2) and 52% extensive colitis (E3) at diagnosis, 16% were active smoking and 66% had an elevated CRP.

Results: During follow-up, 16 CD patients developed a complication (8 strictures, 12 fistula) after a median of 10 (6–24) months. Risk factors were L1 location (LogRank p = 0.002) and elevated baseline CRP (p = 0.043). Interestingly, none of the 7 patients who started combo therapy within 6 months of diagnosis, developed a complication. In Cox regression multivariate analysis, L1 location was the only predictive factor of complication development [Odds ratio 4.0 (95%CI 1.2–12.9), p = 0.022]. In total, 23 CD patients needed resection after a median of 11 (7–26) months. Risk factors were ileal involvement (p = 0.077), B3 behavior (p = 0.053) and elevated baseline CRP (p = 0.059). In multivariate analysis, B3 behavior was the only factor predicting resection [OR 2.9 (1.0–8.3), p = 0.050].

Five UC patients needed colectomy after a median of 14 (11–32) months. Risk factors were elevated baseline CRP (p = 0.084) and need for combo therapy within 1 year (p < 0.001). In multivariate analysis, the need for combo therapy was the only independent predictor [OR 12.0 (1.3–108.3), p = 0.027].

Conclusions: In CD, ileal involvement and fistula were predictive of complicated disease behavior. In UC, the need for combo therapy was predictive for colectomy, probably reflecting a more severe disease course. Later, genetic and serological predictors will be evaluated.