P591. The clinical features and prognosis of Crohn's disease: A Korean multicenter nationwide cohort study
Recently, immunomodulators and anti-tumour necrosis (TNF) factor agents are being more widely used for Crohn's disease (CD) in the most countries including Asia. However, the clinical features and prognosis of patients who were diagnosed with CD in the recent years have not been studied enough. Therefore, a nationwide hospital-based cohort study of Korean patients with CD diagnosed after 2009 was performed to reveal the disease characteristics and outcomes.
Patients with definitive CD were enrolled both prospectively and retrospectively. Web-based case report form was used for data collection. Patients diagnosed with CD after January 2009 were determined to be eligible. The characteristics at diagnosis of CD and the patients' clinical course were analyzed. The study protocol was registered at www.clinicaltrials.gov (NCT01554007).
A total of 465 patients from 26 hospitals were enrolled between January 2009 and October 2013. The male-to-female ratio was 2.8:1 and the median age at diagnosis was 22.4 years (range, 10–65 years). The most common presenting symptom was abdominal pain (64.5%) and 192 patients (41.3%) had active or healed perianal fistulae/abscess. Forty-three (9.2%) and twenty (4.5%) were previously misdiagnosed with intestinal tuberculosis and ulcerative colitis, respectively. Family history of inflammatory bowel disease in the first degree relatives was present in 12 patients (2.6%). The Montreal location at diagnosis was as follows; L1 in 100 (21.5%), L2 in 36 (7.7%), and L3 in 329 (70.8%). The Montreal behaviour at diagnosis was as follows; B1 in 358 (77.0%), B2 in 47 (10.1%), and B3 in 60 (12.9%). The median duration of follow-up was 27 months (range, 0–58 months). The cumulative use rates of thiopurines and anti-TNF agents after 1, 2, and 3 years of diagnosis were 65.5%, 77.5%, and 82.5%, and 12.0%, 19.9%, and 24.8%, respectively. The cumulative intestinal resection rates after 1, 2, and 3 years of diagnosis were 11.0%, 12.1%, and 14.2%, respectively. There was one mortality (0.2%), which was not associated with CD.
Korean patients with CD appear to show male-predominance, high frequency of perianal fistulae/abscess, and low proportion of isolated colonic disease. These findings are consistent with the results of previous Korean studies [1,2].
A substantial proportion of recently diagnosed Korean CD patients appears to receive thiopurine and/or anti-TNF therapy. The short-term clinical course represented by bowel resection rate seems to be favourable. Longer-term follow-up is needed to elucidate the prognosis of this patient cohort.
1. Yang SK, Yun S, Kim JH, et al. (2008), Epidemiology of inflammatory bowel disease in the Songpa-Kangdong district, Seoul, Korea, 1986–2005: a KASID study, Inflamm Bowel Dis. 14(4), 542–549, [http://www.ncbi.nlm.nih.gov/pubmed/17941073].
2. Ye BD, Yang SK, Cho YK, et al. (2010), Clinical features and long-term prognosis of Crohn's disease in Korea, Scand J Gastroenterol. 45(10), 1178–1185, [http://www.ncbi.nlm.nih.gov/pubmed/20560811].