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P249. Endoscopic extension of inflammation progresses more frequently in ulcerative colitis compared to Crohn's disease patients

K. Katsanos1, V. Tsianos1, T. Vasileiou1, A. Tatsioni2, D. Sigounas1, I. Mitselos1, D. Christodoulou1, E. Tsianos1, for the NW Greece IBD Study Group, 1University of Ioannina, Ioannina, Greece, 2Department of Family Medicine University of Ioanninaand Tufts-New England Medical Center Evidence-Based Practice Center, Institute for Clinical Research and Health Policy Studies, Boston, USA, Greece

Background

The purpose of the study was to investigate the changes in endoscopic extension of inflammation during follow up IBD patients.

Methods

Retrospective 30-year study (1982–2011) in a tertiary IBD referral center. All patients were on maintenance therapy and patients with at least two ileocolonoscopies with confirmation biopsies were included. Capsule endoscopy was not available in all patients and was not integrated in analysis. All medical records with corresponding lower gastrointestinal tract endoscopies from 631 (359 males) IBD patients (median age 47.9 years, 443 UC/ 135 CD / 53 indeterminate), were retrieved by two reviewers. Any change (extension) in endoscopic location of each patient was recorded separately.

Results

In total 1736 endoscopies were reviewed (range 2–12 endoscopies per patient). Among 631 IBD patients a change of endoscopic extension of inflammation was observed in 59 (9.3%) of them. The median time of observing those changes in extension of inflammation was 6.8 years (range 4–10 years). Fifty-five patients were diagnosed with UC (93.2%) and 4 with CD (6.8%) while no changes were observed in patients with undetermined colitis. Among 55 UC patients, endoscopic inflammation was extended from proctitis to sigmoid colon (6 patients, 10.9%), from sigmoid colon to splenic flexure (26 patients, 47.3%) and from left-sided (sigmoid or up to the splenic flexure) colitis to pancolitis (23 patients, 41.8%). In CD patients endoscopic inflammation was extended from terminal ileitis to ileocolitis in all 4 patients.

Conclusion

According to this observational study the endoscopy-proven extension of inflammation changes in 9.3% of IBD patients during long-term follow up and this seems to occur more frequently in UC compared to CD patients. This change in extent of IBD macroscopic inflammation needs further investigation also in the view of the new disease-modifying therapies.