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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


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).


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.


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).


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.