P115 Early and late-onset Crohn's disease: different clinical presentation and course, an Italian cohort study
L. Cantoro*1, C. Papi2, M. Cicala3, A. Kohn4
1Azienda Ospedaliera San Camillo-Forlanini, Gastroenterology, Rome, Italy, 2A.O.San Filippo Neri, Gastroenterology and Hepatology Unit, Rome, Italy, 3Campus Bio Medico, Gastroenterology, Rome, Italy, 4Azienda Ospedaliera San Camillo-Forlanini , Gastroenterology, Roma, Italy
Disease heterogeneity, according to age of onset, may be observed in Crohn's disease (CD). The aim of the present study was to compare CD phenotype at diagnosis and disease course in diagnosed patients ≤ 17 years (early) and ≥ 60 years (late), the more critical categories in terms of risks and benefits of therapeutic choices.
Cases included all CD patients diagnosed ≤ 17 years and ≥ 60 years with follow-up > 2 years, recorded in the registry of two IBD referral Centres in Rome. Data reported at diagnosis included gender, smoking habits, IBD family history, IBD location and CD behavior, according to the Montreal classification, extra-intestinal manifestations and medical/surgical treatments performed during the follow-up period. Statistical analysis: Chi-squared test, Kaplan-Meier survival method.
Of the entire cohort of 2321 CD, 160 patients met criteria for the inclusion in the study: 92 in the early-onset (EO) and 68 in the late-onset (LO) group. The median follow-up was 10 years (range 2- 34 years). A family history of IBD occurred more frequently in EO compared to LO (26% vs 4%; p<0.0007). Ileocolonic location, upper gastrointestinal involvement and perianal disease occurred more frequently in EO compared to LO (56% vs 21% p<0.0001; 17% vs 3% p<0.009; 38% vs 19% p<0.01 respectively). Disease behavior at diagnosis was inflammatory in approximately 60% in both group, however progression to complicated disease during follow-up occurred more frequently in EO (40% vs 10% p<0.002).Compared to LO, EO had increased need for steroids and anti-tumor necrosis factor (TNF) alpha during the first two years from diagnosis (41% vs 6%, p<0.003 and 15% vs 4%, p<0.05 respectively). The cumulative probability of receiving steroids, immunosuppressant and anti-TNF alpha within 10 years from diagnosis in EO and LO was 81% and 58% (p=0.004), 58% and 35% (p=0.04), 36% and 16% (p=0.01) respectively. There was no significant difference between the two groups regarding the cumulative probability of surgery within 10 years.
At our knowledge, this is the first Italian study on clinical presentation and course of CD according to age of onset.
Our data are consistent with the literature being ileocolonic location and greater proportion of complicated behavior more common in EO CD. The course of disease in LO CD is more stable and less aggressive than EO CD and should be taken into account when discussing therapeutic choices.