P298 Comparison of the familial and sporadic cases of inflammatory bowel diseases in long-term follow-up regarding step-up treatment, clinical, and biochemical parameters
S. Bozcan*, I. Hatemi, Y. Erzin, G. Ayan, A. Satman, T. Gundogdu, K. Atay, N. Demir, A.F. Celik
Istanbul University Cerrahpasa Medical School, Gastroenterology, Istanbul, Turkey
Phenotypical differences such as disease onset, higher prevalence of the extraintestinal manifestations amongst familial inflammatory bowel diseases (IBD) patients compared with sporadic ones previously have been reported. Moreover, higher prevalence of perianal and penetrating behaviour in familial Crohn’s disease (CD) also have been documented. The aim of this study was to compare the demographic and long-term follow-up features of familial cases with sporadic cases of IBD in our population.
We performed a retrospective chart review of all of our IBD patients to survey demographic features, disease extent, treatment modalities, and the current status of treatment as an indicator of step-up (5-ASA, adding azathioprine [AZA], and anti-TNF) treatment approach, as well as an indicator of clinical severity. Disease location and behaviour, initial and actual acute phase reactants, medications, and surgery rates were noted
In total, 119 familial IBD cases (68 CD, and 51 ulcerative colitis [UC]) were evaluated and compared with 258 sporadic cases (98 CD and 160 UC) chosen according to registry numbers namely 2 sporadic cases adjacent to each index case of familial patients. There was no difference between sex, age at the diagnosis, the rate of extraintestinal manifestations, the rate of appendectomy, or anti-TNF and azathioprine use amongst the familial and sporadic cases of both CD and UC cases (Table 1). Smoking rate in familial cases of UC was less than that in the sporadic cases but it was not different in CD. The rate of perianal disease (37 % in both groups, p = 0.55) and rate of postoperative recurrence (34.4 % in familial, 65.6 % in sporadic cases p = 0.44) and disease locations were not different between familial and sporadic CD patients. The frequency of rectal involvement was higher in familial cases than it was in the sporadic ones in UC patients (55% vs 18%, p = 0.001), but the colectomy rate was not different amongst familial and sporadic cases of UC. According to the last medical treatment modalities familial UC cases were using less immunosuppressives compared with sporadic UC cases (60.1% vs 27.1%, p = 0.001). Initial and actual C-reactive protein (CRP) levels were higher and actual albumin levels lower amongst familial CD cases compared with sporadic cases (p = 0.000; p = 0.031; p = 0.038, respectively).
Although a well-known protective factor namely active smoking is significantly less in familial UC compared with the sporadic cases, significantly less use of immunosuppressives in familial UC indicates a milder disease course, and actually higher isolated rectal involvement in the same group might partially explain the milder nature of it.