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P286. Age at diagnosis and clinical characteristics of Crohn's disease in Korea: a KASID multicenter study

S.W. Hwang1, J. Chun1, J.H. Lim1, J.P. Im1, J.H. Cheon2, B.D. Ye3, J.W. Kim4, Y.S. Kim5, J.S. Kim1, 1Seoul National University College of Medicine, Department of Internal Medicine and Liver Research Institute, Seoul, Korea, Republic of, 2Yonsei University College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 3Ulsan University College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 4Seoul National University Boramae Hospital, Seoul National University College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 5Inje University College of Medicine, Internal Medicine, Seoul, Korea, Republic of

Background

Age at diagnosis is known to influence the clinical course of patients with Crohn's disease (CD), and the late-onset CD may have distinctive characteristics. However, they have not been established in Korea. The aim of the present study was to describe the clinical characteristics and treatment of CD patients according to age at diagnosis in a Korean population.

Methods

This retrospective multicenter cohort study included 1338 Korean patients diagnosed as CD between 1982 and 2008 in 30 hospitals. Age at diagnosis was categorized as <16, 17–40, 41–59 and >60 years old. The location and behavior were classified according to the Montreal classification. The baseline characteristics and clinical outcomes were evaluated, and the use of antibiotics, corticosteroid, immunomodulators and anti-TNF agents were also reviewed.

Results

The proportion of each age at diagnosis group in CD patients was 11.6%, 75.5%, 10.1%, and 2.8%, respectively. As the age at diagnosis increased, ratio of male and presence of perianal fistula significantly decreased (P < 0.001).

Old age at diagnosis group showed a higher frequency of ileal location (14.5, 23.9%, 39.8%, and 41.7% for each age at diagnosis group), whereas young group showed a higher frequency of ileocolonic location (68.4%, 57.7%, 42.9%, and 38.9%) (P < 0.001). In old age at diagnosis group, the frequency of penetrating behaviour was lower than that in young group (P = 0.045).

As age at diagnosis increased, the use of antibiotics, corticosteroid, immunomodulators and anti-TNF agents decreased (P < 0.001), but the rates of hospital admission, intestinal resection and all CD-related surgery did not significantly differ between age groups.

Table 1 (abstract P286). Baseline characteristics of patients with Crohn's disease in KASID cohort
Overall<16 years17–40 years41–59 years>60 yearsP-value
Number1333 (100%)154 (11.6%)1007 (75.5%)135 (10.1%)37 (2.8%)
Male ratio932 (69.9%)97 (63.0%)729 (72.4%)95 (70.4%)11 (29.7%)<0.001
Duration of symptoms before diagnosis (mo)14.9±29.15.9±12.615.7±29.220.1±38.812.6±27.7<0.001
Anti-Tb medication297 (22.3%)25 (16.2%)235 (23.3%)30 (22.2%)7 (18.9%)0.249
Familial history29 (2.2%)8 (5.2%)19 (1.9%)2 (1.5%)0 (0%)0.088
Perianal fistula at diagnosis326 (24.5%)40 (26.0%)272 (27.0%)11 (8.1%)3 (8.1%)<0.001
Follow-up duration (mo)91.1±56.898.4±58.792.1±57.282.9±52.262.1±38.3<0.01
Table 2. Location and behaviour of Crohn's disease in patients of the KASID cohort
Overall<16 years17–40 years41–59 years>60 yearsP-value
Location <0.001
 Ileal323 (24.9%)22 (14.5%)233 (23.9%)53 (39.8%)15 (41.7%)
 Colonic236 (18.2%)26 (17.1%)180 (18.4%)23 (17.3%)7 (19.4%)
 Ileocolonic738 (56.9%)104 (68.4%)563 (57.7%)57 (42.9%)14 (38.9%)
 Upper tract94 (7.1%)10 (6.5%)73 (7.2%)7 (5.2%)4 (10.8%)
Behaviour 0.045
 NSNP769 (57.7%)101 (65.6%)564 (56.0%)76 (56.3%)28 (75.7%)
 Stricturing208 (15.6%)22 (14.3%)156 (15.5%)25 (18.5%)5 (13.5%)
 Penetrating356 (26.7%)31 (20.1%)287 (28.5%)34 (25.2%)4 (10.8%)

Conclusion

The clinical characteristics of older CD patients were different from those of younger patients in the disease location, behaviour, the occurrence of perianal fistula, and the use of therapeutic agents. The results indicated the distinctive characteristics and treatment in older CD patients in Korea.