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P199 Predictive factors of surgery and bowel damage during the course of Crohn’s disease: A population-based study

M.-L. Rabilloud1, J.-F. Bretagne1, E. Bajeux2, L. Siproudhis3, J.-F. Viel2, I. Tron4, G. Bouguen*1

1Université Rennes 1 & CHU Pontchaillou Rennes, Service des Maladies de l’Appareil Digestif, Rennes, France, 2CHU Pontchaillou, Service de Santé Publique, Rennes, France, 3Université Rennes 1 & CHU Pontchaillou Rennes, Service de chirurgie digestive, Rennes, France, 4ORSB, Rennes, France

Background

Outcomes of Crohn’s disease remain poorly predictable. There is a need to identify CD patients early who may evolve to disabling outcomes including bowel damage to early introduce effective treatment and change their natural history. Only population-based studies are able to assess these questions given the selection bias of referral centre studies.

Methods

All incident cases of patients diagnosed with possible CD (n = 370) were registered from 1994 to 1997 in Brittany, a limited area in France. At diagnosis clinical features, endoscopic lesion per ileocolonic segment (according to the CDEIS), radiologic, and histologic data were recorded. All charts of patients were reviewed from the diagnosis to the last clinic in 2015. Cumulative probabilities of surgeries and bowel damage were estimated using the Kaplan–Meier method. Bowel damage was defined according to the criteria that weight the recent Lemann Score (surgery, complicated behaviour, and anoperineal involvement) Independent predictors of all outcomes were identified using a Cox proportional hazards model.

Results

Amongst the 370 incident cases, 39 did not have Crohn’s disease, and 272 of the 331 cases with CD (82%) were reviewed with a median follow-up of 12.8 years. The cumulative probabilities of hospitalisation related to CD were 17%, 31%, 38%, and 42% at 1 year, 5 years, 10 years, and 15 years, respectively. In total, 107 patients underwent surgery after a mean disease duration of 37 months (IQR75 [16–104]). The cumulative probabilities of surgery were 9%, 23%, 32%, and 37%, at 1 year, 5 years, 10 years, and 15 years. Fever at diagnosis (HR = 1.56, CI 95 [1.02–2.39]), abdominal mass at first clinical exam (HR = 2.6, CI 95 [1.14–5.12]), complicated behaviour at diagnosis (stricturing/fistulising) (HR = 2.4, CI 95 [1.52–3.73]) predicted at diagnosis the need for surgery. Bowel damage was observed for 154 patients after a mean disease duration of 15 months. The cumulative probabilities of having bowel damage were 14%, 34%, 44%, and 51%, at 1 year, 5 years, 10 years, and 15 years, respectively. L1 disease (HR = 1.9, CI 95 [1.2–2.9]), diagnostic delay of at least 9 months (HR = 1.7, CI 95 [1.17–2.4]), and extraintestinal manifestation (HR = 1.44, CI 95 [1.01–2.03]) predicted at diagnosis bowel damage in the long term.

Conclusion

Bowel damage and the need for surgery remained common during the course of CD on a population-based setting. Bowel damage occurred early in the course of CD that underlined the need for early diagnosis and early treatment particularly in case of ileal disease with extraintestinal manifestation.