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* = Presenting author

P548 Early intervention of infliximab prevent reoperation for the recurrence of Crohn's disease

M. Ishii*1, K.-i. Tarumi1, T. Kamada1, M. Fujita1, H. Matsumoto1, T. Murao1, R. Nakato1, M. Osawa1, S. Hirai1, S. Fukushima1, N. Manabe2, H. Kusunoki3, A. Shiotani1, J. Hata2, K. Haruma1

1Kawasaki Medical School, Division of Gastroenterology Department of Internal Medicine, Kurashiki, Japan, 2Kawasaki Medical School, Clinical Pathology and Laboratory Medicine, Kurashiki, Japan, 3Kawasaki Medical School, Genaral Medicine, Kurashiki, Japan

Background

We aimed to evaluate the prognostic factors, including early use of infliximab for first surgery and reoperation following first surgery in CD patients in Japan.

Methods

The clinical records of 115 patients who were diagnosed as having CD at Kawasaki Medical School Hospital between January 1987 and July 2012 were retrospectively investigated. The cumulative rate of bowel resection for CD-related intestinal manifestations following onset until first surgery and the cumulative rate of reoperation following first to second surgery were estimated using the Kaplan-Meier method and the related to each factor were statistically analized using the log-rank test. The background factors that influenced the cumulative rate of bowel resection following onset until first surgery and the cumulative rate of reoperation following first to second surgery were evaluated using univariate and multivaliate analyses.

Results

Of these 115 patients, 81 were men, the mean age of onset was 26.2 years, the mean disease duration was 9.69 years, patients who received intravenous infliximab (5 mg/kg) at an 8-week interval within 1 year following onset were 12, patient who received azathioprine within 1 year following onset was 1, ileocolitis-type CD were 68, and 48 patients underwent one or more surgeries. The 3-, 5-, and 10-year cumulative rate of bowel resection following onset were 10.5%, 25.9%, and 39.4%, respectively. On multivariate analysis, the cumulative rate of bowel resection following onset in CD patients was significantly associated with ileocolitis-type CD (hazard ratio [HR], 2.39; p = 0.004) and male sex (HR, 2.23; p = 0.05). Of 48 patients who underwent bowel resection ,19 patients underwent reoperation, the mean age of onset was 25.8 years, the mean disease duration was 8.32 years, patients who received intravenous infliximab (5 mg/kg) at an 8-week interval within 1 year following first surgery (infliximab group) were 22, patients who didn't receive intravenous infliximab within 1 year following first operation (non infliximab group) were 26, patients who received azathioprine within 1 year following first surgery were 10, and ileocolitis-type CD were 33. The 3-, 5-, and 10-year cumulative rate of reoperation following first to second surgery were 10.7%, 20.7%, and 40.9%, respectively. The 5-year cumulative rate of reoperation decreased significantly in infliximab group compared to in non infliximab group (10.6% vs. 28.6%, p = 0.026).

Conclusion

The sex and extent of the disease may be a prognostic factor of bowel resection due to CD-related intestinal manifestations. Early intervention of infliximab is likely to prevent reoperation for the recurrence of Crohn's disease.