Search in the Abstract Database

Search Abstracts 2015

* = Presenting author

P293 The sooner, the better: Early treatment of Crohn's Disease precludes a bad outcome

Y. Gonzalez Lama*, C. Suarez Ferrer, G.P. Irene, M. Calvo Moya, V. Matallana Royo, M.I. Vera Mendoza, L. Abreu Garcia

Hospital Puerta De Hierro, Gastroenterology, Madrid, Spain

Background

Early stages of Crohn's disease (CD) are supposed to be predominantly inflammatory, and it is thought that early treatment of the disease could be one of the keys to change the natural history of the disease. We aimed to confirm this concept in our own experience.

Methods

We retrospectively reviewed the clinical records of all CD patients in our database with a stable follow up in our centre. Dates of diagnosis, of starting immunosuppressive therapy (either thiopurines or biologics), and of the first surgery when appropriate were considered. Patients lacking any of those data on our database were excluded from the analysis.

Results

467 CD patients were included; 71% males, mean age 45yrs (range 18-82 yrs).

We found 422 CD patients with thiopurines. 189 had undergone surgery along the follow up. Those operated patients started thiopurines after a median of 117 months, interquartile range (IQR) 44-196 months since diagnosis, while non-operated CD patients started thiopurines after a median of 30 months IQR 6-128 months; p<0,001. The Odds ratio for undergoing surgery was 1,006 (CI95% 1,004-1,008) for each month of delay in starting thiopurines.

We found 272 CD patients with biologics. 137 had undergone surgery along the follow up. Those operated patients started biologics after a median of 166 months IQR 90-233 months since diagnosis, while non-operated CD patients started thiopurines after a median of 59 months IQR 14-162 months; p<0,001. The Odds ratio for undergoing surgery was 1,008 (CI95% 1,005-1,010) for each month of delay in starting biologics.

We found 467 CD patients with thiopurines and/or biologics. 210 had undergone surgery along the follow up. Those operated patients started any immunosuppressant after a median of 120 months IQR 48-197 months since diagnosis, while non-operated CD patients started thiopurines after a median of 30 months IQR 6-126 months; p<0,001. The Odds ratio for undergoing surgery was 1,008 (CI95% 1,005-1,010) for each month of delay in starting immunosuppressants.

Conclusion

Early treatment of CD is associated with a better outcome and could be useful to change the natural course of the disease since avoids surgery in our experience. Each month of delay (since diagnosis) add risk of surgery and should be taken into account.