P680 Post-operative clinical recurrence of Crohn's Disease in clinical practice in Spain. Practicrohn, a retrospective study
E. Domènech*1, V. García2, M. Barreiro3, A. Gutiérrez4, M.D. Martín Arranz5, B. Juliá6, L. Cea-Calvo6
1Hospital Universitari Germans Trias i Pujol and CIBERehd, Gastroenterology Unit, Badalona, Spain, 2Hospital Universitario Reina Sofia, Unidad Clinica de Aparato Digestivo, Cordoba, Spain, 3Complejo Hospitalario Universitario de Santiago, Gastroenterology Unit, Santiago de Compostela, Spain, 4Hospital General Universitario Alicante, Gastroenterology unit, Alicante, Spain, 5Hospital Universitario La Paz, Gastroenterology Unit, Madrid, Spain, 6MSD Spain, Medical Department, Madrid, Spain
Preventive strategies for post-operative Crohn's disease (CD) are not well established. Our aim was to describe the clinical management of CD after ileocolonic surgery and the incidence of clinical recurrence in clinical practice, after a follow-up of up to 5 years.
PRACTICROHN is a retrospective study on CD patients aged ≥ 18 years-old who underwent ileocolonic or ileorectal resection between January 2007 and December 2010 from 26 Spanish hospitals. Patient's data before and up to 5 years after surgery were collected from clinical records. We excluded patients that were prescribed an anti-TNF for post-operative recurrence prevention. Clinical recurrence was defined as presence of abdominal pain, diarrhea, perianal complication, abdominal mass or symptoms suggestive of active CD. The chi-square test was used to analize the 5-year cumulative incidence of clinical recurrence, Kaplan-Meier method was used to assess time to clinical recurrence and a log-rank test was performed to obtain the statistical significance.
191 patients were included (mean age 46 ± 13 years, 49% men). Of these, 93 (48.7%) were smokers at CD diagnosis and 69 out of 93 (74.2%) kept on smoking after surgery. Median time from CD diagnosis to surgery was 7.4 years (IQR 25-75: 0.9-11.2). Reasons for surgery were: penetrating complication (27.2%), intestinal stenosis (44.5%), stenosing + penetrating complication(13.6%), refractoriness to medical treatment (4.2%) and others (10.5%). Only 39.7% started primary medical prevention of postoperative recurrence (immunomodulators (IMM) 27.6%, antibiotics 11%), whilst 61.3% received no preventive treatment. The probability of clinical recurrence at 1, 3 and 5 years was 32.5%, 51.3% and 59.2%, respectively. Smoking did not affect the 5-year probability of clinical recurrence. The 5-year cumulative probability of clinical recurrence was lower in those who received IMM as preventive therapy (42.2%) than in those with no preventive therapy (68.0%) p=0.0034. Comparison of survival curves (log rank) showed that preventive treatment with IMM were associated with lower clinical recurrence and a longer time to clinical recurrence (1042 days; from 676 to >1825) vs no treatment (617 days; from 335 to 1006) p= 0.043. Recurrence in those receiving antibiotics was 50.0% (p=NS). During 5-year follow-up, 19 patients (9.9%) needed surgical reintervention with no associated risk factors.
More than half the patients developed clinical recurrence after CD surgery, being lower in those patients with post-operative recurrence prevention with IMM. Although IMM preventive treatment reduced the risk and time to clinical recurrence, the 5-year incidence of clinical recurrence despite IMM was also considerably high.