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P591. The clinical features and prognosis of Crohn's disease: A Korean multicenter nationwide cohort study

Background

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.

Methods

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).

Results

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.

Conclusion

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].

  • Written by:

    B.D. Ye1, D.S. Han2, E.J. Youn1, J.H. Lee3, J.H. Cheon4, H.-S. Kim5, H.-S. Kim6, Y.-H. Kim7, Y.S. Kim8, S.-A. Jung9, K.-M. Lee10, C.K. Lee11, S.J. Park4, G.S. Seo12, J.S. Kim13, J.P. Im13, C.H. Choi14, D.I. Park7, B.I. Jang15, J.M. Cha11, K.C. Huh16, J.W. Kim17, H.J. Song18, Y.S. Park19, H.J. Jang20, S.H. Jung21, S.W. Jung22, G.H. Baik23, J.S. Koo24, J.-O. Kim25, T.O. Kim26, G.A. Song27, Y.E. Joo5, S.J. Shin28, S.M. Yoon29, Y.T. Jeen30, S.-K. Yang1, H.J. Kim11, W.H. Kim4, 1University of Ulsan College of Medicine, Asan Medical Center, Gastroenterology and Inflammatory Bowel Disease Center, Seoul, Korea, Republic of, 2Hanyang University Guri Hospital, Hanyang University College of Medicine, Internal Medicine, Guri, Korea, Republic of, 3Seoul Song Do Colorectal Hospital, Digestive Endoscopic Center, Seoul, Korea, Republic of, 4Yonsei University College of Medicine, Internal Medicine and Institute of Gastroenterology, Seoul, Korea, Republic of, 5Chonnam National University Medical School, Internal Medicine, Gwangju, Korea, Republic of, 6Yonsei University Wonju College of Medicine, Internal Medicine, Wonju, Korea, Republic of, 7Sungkyunkwan University School of Medicine, Medicine, Seoul, Korea, Republic of, 8Seoul Paik Hospital, Inje University College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 9Ewha Womans University School of Medicine, Internal Medicine, Seoul, Korea, Republic of, 10St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Internal Medicine, Suwon, Korea, Republic of, 11Kyung Hee University School of Medicine, Internal Medicine, Seoul, Korea, Republic of, 12Wonkwang University College of Medicine, Internal Medicine, Digestive Disease Research Institute, Iksan, Korea, Republic of, 13Seoul National University College of Medicine, Internal Medicine and Liver Research Institute, Seoul, Korea, Republic of, 14Chung-Ang University College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 15Yeungnam University College of Medicine, Internal Medicine, Daegu, Korea, Republic of, 16Konyang University College of Medicine, Internal Medicine, Daejeon, Korea, Republic of, 17Seoul National University Boramae Hospital, Internal Medicine, Seoul, Korea, Republic of, 18Jeju National University School of Medicine, Internal Medicine, Jeju, Korea, Republic of, 19Eulji University School of Medicine, Internal Medicine, Seoul, Korea, Republic of, 20Hallym University College of Medicine, Internal Medicine, Hwaseong, Korea, Republic of, 21Eulji University School of Medicine, Internal Medicine, Daejeon, Korea, Republic of, 22University of Ulsan College of Medicine, Ulsan University Hospital, Internal Medicine, Ulsan, Korea, Republic of, 23Hallym University College of Medicine, Internal Medicine, Chuncheon, Korea, Republic of, 24Korea University College of Medicine, Internal Medicine, Ansan, Korea, Republic of, 25Soonchunhyang University College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 26Haeundae Paik Hospital, Inje University College of Medicine, Internal Medicine, Busan, Korea, Republic of, 27Pusan National University School of Medicine, Internal Medicine, Busan, Korea, Republic of, 28Ajou University School of Medicine, Gastroenterology, Suwon, Korea, Republic of, 29Chungbuk National University College of Medicine, Internal Medicine, Cheongju, Korea, Republic of, 30Korea University College of Medicine, Internal Medicine, Seoul, Korea, Republic of