P181. Natural history of non-severe IBD at diagnosis
C. Pirard, E. Louis, C. Reenaers, CHU de Liege, Gastroenterologie, Liege, Belgium
Crohn's disease (CD) and ulcerative colitis (UC) are progressive diseases characterized by the occurrence of complications requiring immunomodulators and surgery. Few data are available for the prevalence and the factors associated with long-term non-severe (NS) inflammatory bowel diseases.
Our aim was to asseess the natural history of NS CD and NC UC at diagnosis and to identify predictive factors of mild evolution over the long term.
A retrospective study of the IBD patients registred in the database of the university hospital of Liège, Belgium. NS CD was defined as the absence of stricturing, penetrating or perianal disease, no treatment with immunomodulators and anti-TNF, no need for surgery in the course of the disease. NS UC was defined as no requirement for immunomodulators, anti-TNF and colectomy. Patients were assessed at 1 year, 5 years and at the maximum follow-up. Patients with less than 5 years of follow-up were excluded.
Among 887 patients, a subgroup of 439 CD and 173 UC were included with a mean follow-up of 19 and 15 years respectively. One year after the diagnosis 147 CD patients had NS CD. At 5 years and at the maximum follow-up respectively, 83/147 (56%) and 15/147 (10%) patients still had NS CD. Complications were strictures (29%), fistulizing disease (18%), perianal disease (37%). Immunomodulators and anti-TNF were required in 79% and 54% of patients respectively. Prognostic factors for persistent NS CD were older age at diagnosis (38 vs 26 years, p = 0.005), no corticosteroid during the first year (p = 0.036). In UC, 142 patients had NS disease one year after the diagnosis. 102/142 (72%) and 62 patients (44%) had NS UC after 5 years and at the maximum follow-up respectively. Surgery occurred in 19 patients (13%) after a mean time à 164 months. Immunomodulators were needed in 66 patients (47%) and anti-TNF in 37 patients (26%). NS UC was associated with absence of hospitalization for active UC over the first 5 years (p = 0.009) and during the total course of UC (p < 0.0001), no intake of corticosteroid during the first year (p = 0.03).
In our cohort representing referall centre recruitment, nearly all CD patients and 2/3 of UC with NS disease at diagnosis became severe with time. Old age at diagnosis was associated with NS CD outcome while absence of hospitalisation during the first year was associated with NS UC outcome. Absence of steroid use during the first year was associated with NS outcome in both diseases.