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* = Presenting author

P095 Lewis Score - prognostic value in patients with isolated small bowel Crohn's disease

F. Dias de Castro*1, P. Boal Carvalho1, S. Monteiro1, B. Rosa1, M.J. Moreira1, J. Cotter1, 2, 3

1Centro Hospitalar do Alto Ave, Gastroenterology, Guimaraes, Portugal, 2School of Health Sciences, University of Minho, Life and Health Sciences Research Institute (ICVS), Braga, Portugal, 3PT Government Associate Laboratory, ICVS/3B’s, Braga/Guimarães, Portugal

Background

Small bowel capsule endoscopy (SBCE) allows for the characterization of inflammatory activity and distribution of small bowel lesions in Crohn's disease (CD), contributing to therapeutic strategy in these patients. We aimed to assess the prognostic value of the severity of inflammatory lesions, quantified by the Lewis Score (LS), in patients with isolated small bowel CD.

Methods

Retrospective study, between 2008 and 2013, including 49 patients with isolated small-bowel CD, submitted to SBCE at the time of diagnosis. LS was assessed and patients included had at least 12 months of follow-up after diagnosis. The variables defined as adverse events were corticosteroid therapy, hospitalization and surgery during follow-up. The incidence of adverse events were analysed and compared in patients with higher LS (LS ≥ 790), corresponding to moderate or severe inflammatory activity, versus patients with mild inflammatory activity (LS between 135 and 790). Statistics were performed with SPSS v.20.0.

Results

49 patients included, 63,3% were female with mean age 33 years and mean follow-up of 44 months. Global LS was ≥ 790 in 21 patients (43%), while 57% presented with LS between 135 and 790. The two groups were similar for mean follow-up, family history of CD, extraintestinal manifestations, history of appendicectomy, perianal disease and mean levels of haemoglobin, erythrocyte sedimentation rate, C-reactive protein and ferritin at the time of SBCE. Patients with higher LS were more frequently smokers (p=0,01), were more frequently under immunosuppressive therapy (p=0,006), had more often incomplete SBCE examinations (p=0,01) and had lower albumin mean levels (p=0,002). During follow-up, patients with moderate to severe inflammatory activity in SBCE were more frequently submitted to surgery (p=0,045), had more hospitalizations for CD flares (p=0,008) and needed more frequently corticosteroid therapy (p=0,009) in comparison to those patients with mild inflammatory activity.

Conclusion

in patients with moderate to severe inflammatory activity (LS ≥ 790) there was a higher prevalence of corticosteroid therapy demand, hospitalizations and surgeries during follow-up compared with patients with mild inflammatory activity (LS<135). Thus, the stratification of the degree of inflammatory activity in EC by the LS at the time of diagnosis may have a relevant prognostic value in patients with isolated small-bowel CD.