P116. What is the prognosis of silent Crohn's disease?
A. Esch1, A. Bourrier2, P. Seksik2, I. Nion-Larmurier2, H. Sokol2, L. Beaugerie2, J. Cosnes2, 1Hôpital Cochin, Gastro-Entérologie, Paris, France, 2Hôpital Saint Antoine, Gastro-Entérologie, Paris, France
Intestinal lesions of Crohn's Disease (CD) may be discovered in patients without symptoms (“silent” CD). The aim of this study was to describe the evolution of silent CD, in comparison with post-operative endoscopic recurrence and classical clinically active CD.
We selected symptom-free patients at diagnosis of CD from the monocentric MICISTA database which included in 2012 May, 4717 cases of CD. Evolution of CD in these patients (SI group) was compared to two control groups matched on age, sex and date of finding of the intestinal lesions: (i) patients with post-operative endoscopic recurrence without clinical symptoms (OP Group), and (ii) patients clinically active at diagnosis (CA group). The primary endpoint was the time to first CD symptoms in the SI group and in the OP group. Other endpoints in the 3 groups were time to development of a complication (stricture or perforation), and time to surgery.
There were 43 patients (23 males, 20 females, age 43±16 years) in the SI Group. CD lesions were found incidentally in 32 cases and because of associated diseases in 11 cases (5 ankylosing spondylitis, 2 primary sclerosing cholangitis and 4 fissura-in-ano). During follow-up (median 78 months [range 3–216]), 31 patients (72%) developed symptoms after a median time of 46 months (range 2–109), 10 developed a CD complication and subsequently required surgical resection. The 5-year cumulative risks of symptomatic disease, complication, and surgery, were 0.64±0.08, 0.22±0.07, and 0.10±0.05, respectively in the SI group. The evolution was similar in the OP group, with 5-year cumulative risks of symptomatic disease, complication, and surgery of 0.64±0.08 (NS), 0.33±0.08 (NS), and 0.10±0.05 (NS), respectively. By contrast, the evolution was significantly more severe in the CA group with 5-year cumulative risks of complication and surgery of 0.56±0.08 (p < 0.001) and 0.47±0.08 (p = 0.004), respectively. Annual activity (percentage of patients having a flare each year) was not significantly different between SI and OP groups but significantly higher in the CA group during the first 3 years of follow-up; later on, annual activity was not different from one group to another.
Natural history of silent CD reproduces the model of post-operative recurrence, from endoscopic lesions to symptoms and complications. Close monitoring of these patients, similar to what is recommended in patients operated on, is warranted.