P611 First intestinal resection in Crohn's Disease . A long term prospective study
N. Bounab*1, A. Balamane1, L. Kecili1, A. Bousseloub2, K. Belhocine1, K. Layaida1, N. Kaddache1, L. Gamar1, T. Boucekkine1, S. Berkane1
1CHU Mustapha, Faculty of Medicine, Algiers, Algeria, 2Hôpital Central de l'armée , Faculty of Medicine, Algiers, Algeria
Surgical resection rates in Crohn's disease (CD) are high ranging from 25 to 61% at 5 years .Need for surgery remains impredictable. Identifing of predictors for surgery may be of interest for medical therapeutic strategies.
To determine surgical rates, characteristics and predictive factors of the first intestinal resection in CD, we have studied the outcome of a cohort of 226 CD patients (103 males: M ;123 females :F) , hospitalized in 3 Gastroenterological units in Algiers from 1/1/2000 to 31/12/2004 and included in a prospective follow-up for at least 5 years or until surgical resection. Mean age at inclusion was 30,6 ± 6,5 years. 41 patients(18,1%) were smokers. Disease was located in both colon and small intestine (CSI ; n=116 ;51,4%), small intestine alone (SI ;n= 67;29,6%) or colon alone (C ; n=43 ;19%). Lesions were of inflammatory (I) ,stricturing (S) or penetrating (P) type in 92 (40,7%), 76 (33,6%), 58(25,7%) cases respectively . Medical treatment of flares was a conventional one and adapted to their severity ;relapses were prevented by 5ASA (n=125 ;
65,3%) or immunosuppressive drugs (n=32 ;14,1%) ;69 patients (30,5%) received no maintenance treatment. Statistical analysis:Student Fisher's test and Mann Whitney's U test.
The 5-year intestinal resection rate was 29,6% (n=67/226). Annual rate of surgery increased according to duration of disease and varied from 4% between the first and second year to 7% between the forth and the fifth year of follow-up. Emergent surgery was needed in 24/226 patients (10,6%) and elective one in 19%(n=43/226) of all the cases. During the follow-up surgical resection was more frequent : 1/ when disease begun before 20 years old (n=13/29 ; 44,8%) comparatively to patients aged between 20 and 40 years (n=46/160 ; 28,7% ; p<0,001) or over 40 years ( n=8/37 ; 21,6% ) :p< 0,1103 ; thus 31,2% ( n=59/189) were operated upon before 40 years. 2/ in patients with SI (n=35/116 ; 37,5% ) or CSI (25/67 ;30,4%) location compared to patients with C location of the disease (n=7/43 ;16,3% ) : p=0,06 ; 3/ in patients with S (n=38/76 ;50%) or P disease (n=23/53 ;43,4%) comparatively to I type of lesions at inclusion (n=6/92 ;6,5% ) : p=0,0019. In return, rate of surgical resection was not influenced by : 1/ gender (F=37/123=30%, M=30/103 = 29,1% ; p >0,05) ; 2/ Smoking status of patients ( smokers :10/33 ; 30,3% , previous smokers ( n=5/15 ; 33,3%) and non smokers (52/170 ; 30,5%) ; p>0,05.
In this prospective study,the 5-year surgical rate of the first intestinal resection in Crohn's disease was 29,6%. The need for surgery was more frequent, but not statistically significant when disease begun before 20 years, in stenosing and penetrating disease and in SI or CSI location.