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P666 Changing disease patterns in Crohn's disease; experience from Malta

J. Schembri*, N. Azzopardi, P. Ellul

Mater Dei Hospital, Department of Gastroenterology, Tal Qroqq, Malta


In Malta the incidence of Crohn's disease (CD) has been estimated at 0.96/100,000 per year in males and 1.62/100,000 per year for females. These rates are amongst the lowest in Europe [1]. Nonetheless over recent years we have noticed changing disease patterns with increasing disease frequency amongst younger patients.


We conducted a cross-sectional survey looking at disease patterns, treatment and surgical outcomes of 181 Maltese patients with CD who came for routine follow up between January 2013 and July 2014.


Gender distribution was similar, with a slight male preponderance (51.4%;n=93). Age at diagnosis was positively skewed towards younger age groups.


ECCOJC jju027 P666 F0001

“Histogram demonstrating age distribution of Maltese patients with Crohn’s disease followed up between January 2013 and July 2014”

Older age at diagnosis was associated with a higher risk of surgery (p=0.18). This was especially true for those older than 50, 61.1% of whom required surgery (n=11;p=0.01). Gender was also associated with a greater need for surgery, males being twice as likely to undergo intervention (47.6% males, 23.9% females;p=0.47). Mean delay between diagnosis and initial surgery was similar for all groups. Disease behaviour and location were significantly associated with need for surgery, B3 and L3 disease predisposing towards intervention (p=approx 0 and 0.20 respectively). A significant proportion of newly diagnosed patients are those aged 10 and under (8.8%;n=16). Amongst this group only 1 patient required surgery. Out of the 5 patients under 16 who did require surgery, 3 had been previously diagnosed with UC and underwent panproctocolectomy and 1 was operated upon before a diagnosis of CD was suspected. All cases had perianal disease at presentation and had not undergone upper endoscopy. Biologic and thiopurine use was common (50.3% and 66.9% respectively). Those aged 50 and older at diagnosis were less likely to be treated with antiTNF agents (38.9%;n=7) compared to those younger than 50 (51.5%;n=84). On average biologics were started 5.6 years (95%CI +/- 1.3 years) after diagnosis and 2.8 years (95%CI +/- 1.9 years) after surgery.



CD is being increasingly diagnosed in younger patients. Surgery in this group is usually as a consequence of unrecognised disease and may be avoidable. Our data shows more aggressive disease behaviour with increasing age. In spite of the fact that those who are diagnosed with CD at an older age are more likely to require surgery, biologic agents are being used less frequently in this group. Additionally we are not able to explain the significant gender difference suggesting more severe disease in males.


[1] Cachia E, Calleja N, Aakeroy R, Degaetano J, Vassallo M, (2008), Incidence of inflammatory bowel disease in Malta between 1993 and 2005: a retrospective study., Inflammatory Bowel Disease, 550-3, (14)4, Department of Gastroenterology, Malta