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P727 Change in Crohn's disease behavior in a prospective European population-based inception cohort – the ECCO-EpiCom cohort

Burisch J.*1, Halfvarson J.2, Kupcinskas L.3, Hernandez V.4, Kaimakliotis I.5, Valpiani D.6, Pedersen N.7, Duricova D.8, Kievit L.9, Dahlerup J.F.10, Fumery M.11, Salupere R.12, Arebi N.13, Nielsen K.R.14, Giannotta M.15, Oksanen P.16, Katsanos K.H.17, Vegh Z.18, Ellul P.19, Schwartz D.20, Čuković-Čavka S.21, D'Incà R.22, Turcan S.23, Magro F.24,25,26, Goldis A.27, Langholz E.28, Lakatos P.L.18, Munkholm P.1 EpiCom Study Group

1North Zealand University Hospital, Department of Gastroenterology, Frederikssund, Denmark 2Faculty of Medicine and Health, Örebro University, Department of Gastronterology, Örebro, Sweden 3Lithuanian University of Health Sciences, Institute for Digestive Research, Kaunas, Lithuania 4Complexo Hospitalario Universitario de Vigo, Gastroenterology Department, Vigo, Spain 5Nicosia Private practice, Nicosia Private practice, Nicosia, Cyprus 6Department of Gastroenterology and Digestive Endoscopy, Morgagni Hospital, Forli, Italy 7Slagelse Hospital, Department of Gastroenterology, Slagelse, Denmark 8Charles University, IBD Center ISCARE, Prague, Czech Republic 9Herning Central Hospital, Department of medicine, Herning, Denmark 10Aarhus University Hospital, Department of Hepatology and Gastroenterology, Aarhus, Denmark 11Amiens University and Hospital, Epimad Registry, Gastroenterology Unit, Amiens, France 12Tartu University Hospital, Division of Endocrinology and Gastroenterology, Tartu, Estonia 13St Mark's Hospital, Gastroenterology, London, United Kingdom 14The National Hospital of the Faroe Islands, Medical department, Tόrshavn, Faroe Islands 15AOU Careggi Regional Referral Center for Inflammatory Bowel Disease, Gastroenterology Department, Florence, Italy 16Tampere University Hospital, Department of Gastroenterology and Alimentary Tract Surgery, Tampere, Finland 17University Hospital, Ioannina, 1st Division of Internal Medicine and Hepato-Gastroenterology Unit, Ioannina, Greece 18Semmelweis University, 1st Department of Medicine, Budapest, Hungary 19Mater Dei Hospital, Division of Gastroenterology, L-Imsida, Malta 20Soroka Medical Center and Ben Gurion University of the Negev, Department of Gastroenterology and Hepatology, Beer Sheva, Israel 21University Hospital Center Zagreb, University of Zagreb School of Medicine, Division of Gastroenterology and Hepatology, Zagreb, Croatia 22Azienda Ospedaliera di Padova, Department of Surgery, Oncology and Gastroenterology, Padova, Italy 23State University of Medicine and Pharmacy of the Republic of Moldova, Department of Gastroenterology, Chisinau, Moldova, Republic of 24University of Porto, Institute for molecular and cell biology, Porto, Portugal 25Hospital de São João, Department of Gastroenterology, Porto, Portugal 26Oporto Medical School, Institute of Pharmacology and Therapeutics, Porto, Portugal 27University of Medicine “Victor Babes”, Clinic of Gastroenterology, Timisoara, Romania 28Gentofte Hospital, Department of Medical Gastroenterology, Copenhagen, Denmark

Background

Crohn's disease (CD) is a progressive disease that over time can lead to the development of complications such as strictures or internal penetrating disease that will ultimately lead to surgery. Only few population-based studies from the biological era and widespread use of immunodulators have investigated the change in disease behaviour and subsequent risk of surgery in CD.

Methods

The EpiCom-cohort is a population-based cohort of unselected patients with inflammatory bowel disease diagnosed in 2010 in Eastern and Western European centres. Patients were followed prospectively for five years and clinical data were captured throughout the follow-up period and entered in a validated web-based database. Disease behaviour as defined according the Montreal classification as B1: non-stricturing, non-penetrating, B2: stricturing; B3: penetrating based on endoscopy, cross-sectional imaging or surgery. The risk of changing behaviour from B1 to B2 or B3 as well as the risk of surgical resection was analysed by Cox regression analyses using the proportional hazard assumption including multiple covariates (age, gender, disease location, diagnostic delay, smoking status, change in behaviour, geographic region, and early treatment with biologics).

Results

The EpiCom-cohort is a population-based cohort of unselected patients with inflammatory bowel disease diagnosed in 2010 in Eastern and Western European centres. Patients were followed prospectively for five years and clinical data were captured throughout the follow-up period and entered in a validated web-based database. Disease behaviour as defined according the Montreal classification as B1: non-stricturing, non-penetrating, B2: stricturing; B3: penetrating based on endoscopy, cross-sectional imaging or surgery. The risk of changing behaviour from B1 to B2 or B3 as well as the risk of surgical resection was analysed by Cox regression analyses using the proportional hazard assumption including multiple covariates (age, gender, disease location, diagnostic delay, smoking status, change in behaviour, geographic region and treatment with biologics within 6 months from diagnosis).

Table 1. Disease behaviour in Crohn's disease at diagnosis and follow-up

At diagnosisAt follow-upTotal (diagnosis)
B1: non-stricturing, non-penetratingB2: stricturingB3: penetrating
B1: non-stricturing, non-penetrating248 (58%)35 (8%)12 (3%)295 (70%)
B2: stricturing80 (19%)14 (3%)94 (22%)
B3: penetrating35 (8%)35 (8%)
Total (follow-up)248 (58%)115 (27%)61 (14%)424 (100%)

Conclusion

In this European population-based inception cohort of unselected CD patients 14% of patients progressed to B2 or B3 after five years of follow-up. The risk of surgery was increased in patients with B1 who progressed to B2/B3. No clinical predictors for progression in behaviour including smoking and treatment with biological therapy could be identified.