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P535. Clinical predictors of immunomodulation and phenotype progression in Crohn's disease

E. Rodrigues-Pinto, F. Magro, R. Coelho, P. Andrade, J. Santos-Antunes, S. Lopes, G. Macedo, Centro Hospitalar São João, Gastroenterology Department, Porto, Portugal

Background

Crohn's disease (CD) has a progressive course with decreasing frequency of inflammatory pattern [B1] and increasing frequency of stenotic [B2] and/or penetrating [B3] phenotype. Our aim was to evaluate clinical criteria for earlier initiation of immunomodulators or anti-tumor necrosis factor alpha (antiTNF alfa), as well, as earlier change of the phenotype (B1 to B2 or B3).

Methods

Study based on prospectively collected data from a CD database in an inflammatory bowel disease (IBD) outpatient clinic. B1 corresponds to a non-stenosing non-penetrating disease, B2 to a stenosing behaviour and B3 to a penetrating one.

Results

Azathioprine was started earlier in male patients (63 months [47.4, 78.6] vs 71 months [52.8, 89.2], p = 0.005) and in patients with involvement of the upper gastrointestinal tract [L4], regarding patients with ileocolic [L3], colonic [L2] or ileal [L1] involvement (51 months [31.3, 70.6] vs 60 months [43.6, 76.4] vs 71 months [32.4, 109.6] vs 84 months [66.1, 101.8], p = 0.026). AntiTNF alfa therapy was started earlier in patients diagnosed before 40 years old (p = 0.004) and in patients with perianal disease (197 months [145.0, 249.0] vs 341 months [276.0; 406.0] p < 0.001). The change in phenotype was earlier in patients with L4 location in respect to L1, L2 or L3 (95 months [58.6, 131.4] vs 138 months [99.3, 176.7] vs 174 months [128.2, 219.8] vs 253 months [200.0, 306.0], p < 0.001), as well as, in male patients (128 months [99.0, 157.0] vs 195 months [154.7, 235.3], p = 0.004).

Conclusion

Diagnosis before 40 years old, the involvement of the upper gastrointestinal tract, perianal disease and male gender are associated with an increased need for immunomodulation and earlier progression of phenotype.