P225 Anticipate to defer: predicting surgical outcome at the moment of diagnosis of Crohn's disease
T. Cúrdia Gonçalves1, M. Costa2, M.J. Moreira*1, J. Cotter1, 3, 4
1Centro Hospitalar do Alto Ave, Gastroenterology, Guimarães, Portugal, 2University of Minho, School of Health Sciences, Braga/Guimarães, Portugal, 3University of Minho, Life and Health Sciences Research Institute, Braga/Guimarães, Portugal, 4University of Minho, ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
Several risk factors for surgery in Crohn's disease (CD) have been identified. However, little is known about predictors of surgery at the precise moment of the diagnosis, which could be determinative when considering the use of more aggressive medical therapies. The aim of this study was to identify risk factors for abdominal surgery at the time of diagnosis of CD.
Retrospective case-control study of patients followed in our department for CD. Cases were patients who had undergone an operation for CD as defined by standard clinical criteria. Controls were patients without any prior surgical treatment for CD. Data related to age, gender, family history, smoking, symptoms, extraintestinal manifestations (EIM), laboratory values, Montreal classification and medical treatment used at presentation were collected. Statistical analysis was performed using SPSSv20.
A total of 279 patients were included in the final analysis: 76 patients in the case group and 203 in the control group. There were no differences in the mean age, gender or family history between groups but smoking were significantly more common in operated patients(p=0,014). Abdominal pain(p=0,013) and diarrhea(p<0,001) were more commonly found at the moment of diagnosis of CD in patients requiring surgery, while fever, weight loss and blood loss were not different between groups. No differences were found in cutaneous, ocular, articular or thromboembolic EIM. Cases were more prone to have lower hemoglobin values(p<0,001), thrombocytosis(p<0,001) and higher C-reactive protein(CRP)(p<0,001) and erythrocyte sedimentation rate(ESR) values(p=0,009). Leukocyte count and ferritin did not differ significantly. As for Montreal classification, ileocolonic location(p<0,001), penetrating or stricturing disease(p<0,001) and perianal disease(p=0,036) were more common in cases, but there were no differences in upper gastrointestinal involvement or in age of diagnosis. Cases had antibiotics prescribed at presentation more commonly(p=0,021), but the use of topic steroids(p=0,001) or aminosalicylates(p=0,004) was rarer. No differences were found in the use of systemic steroids.
At the moment of diagnosis of CD, smoking, abdominal pain, diarrhea, lower hemoglobin values and higher CPR, ESR or platelet values, as well as ileocolonic location of the disease, penetrating or stricturing disease, and perianal involvement are associated with a subsequent surgical outcome. The early recognition of these features in newly diagnosed patients should be seriously taken into account when deciding for more aggressive medical treatments, such as immunosuppressors or biological agents, in order to defer the more invasive surgical procedures.