Search in the Abstract Database

Abstracts Search 2019

P240 Surgical resection in a tertiary IBD centre in Southeastern Brazil: clinical aspects and associated factors

S. da Costa Ferreira*1, L. Cavalcanti Dias Xavier1, P. Maria Lemos1, L. Rose Otoboni Aprile1, B. Bezerra Martins de Oliveira1, I. Steltenpool Tonin Borges1, R. Serafim Parra2, M. Ribeiro Feitosa2, O. Féres2, J. Joaquim Ribeiro da Rocha2, L. E. de Ameida Troncon1

1Division of Gastroenterology, Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Brazil, Ribeirao Preto, Brazil, 2Division of Coloproctology, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Brazil, Ribeirao Preto, Brazil

Background

Despite the numerous advances in medical treatment, it is estimated that a significant percentage of patients with IBD requires bowel resection at least once. The aim of this study was to evaluate patient characteristics and factors associated to surgical resection in patients with IBD in a tertiary IBD unit in Southeastern Brazil.

Methods

Retrospective analysis of data from 446 patients with IBD in follow-up at the University Hospital, Ribeirão Preto Medical School, from January 2000 up to December 2016. Medical records data comprised age, gender, disease type (Crohn’s disease [CD] or ulcerative colitis [UC]), disease location, disease behaviour, disease duration and smoking. Patients were divided into two groups: presence or absence of surgical resection.

Results

Out of the 446 patients, 143 (111 CD and 32 UC) underwent surgical resection (53.2% female, 82.9% Caucasians, mean age: 45.49 ± 13.30 years). Main indications for surgery were: stenosis (10.3%), clinical intractability (6.5%) and massive haemorrhage (2.7%). Smoking (p = 0.0109, OR = 2.244; 95% CI: 1.237 to 4.056), stenotic phenotype (p < 0.0001, OR = 5.294; 95% CI: 3.073 to 9.1212), ileo-colonic location (p < 0.0001, OR = 3.447; 95% CI: 2.061 to 5.698) and longer disease duration (15.17 ± 9.19 vs. 7.94 ± 5.96 years) [p < 0.0001] were significantly associated with operations for CD. Longer duration (21.15 ± 21.58 vs. 9.79 ± 7.08 years) [p < 0.0001] and pancolitis (p = 0.0014; OR = 3.823; 95% CI: 1.698–8.605) were associated with surgical resection in UC. This results are summarised in Tables 1 and 2.

VariableOR (95% CI)p-Value
Smoking2.244 (1.237–4.056)0.0109
Stenotic phenotype5.294 (3.073–9.1212)<0.0001
Ileo-colonic location3.447 (2.061–5.698)<0.0001
Longer disease duration (mean)15.17 ± 9.19 years<0.0001

Clinical factors associated with higher risk of surgery in Crohn’s disease

VariableOR (95% CI)p-Value
Longer disease duration (mean)21.15 ± 21.58 years< 0.0001
Pancolitis3.823 (1.698–8.605)0.0014

Clinical factors associated with higher risk of surgery in ulcerative colitis.

No significant differences were observed in relation to gender, race, age at diagnosis, and previous use of corticosteroids.

Conclusion

Need for surgical treatment is still frequent in patients with IBD. Smoking (current or past), longer disease time, stenotic phenotype, and ileo-colonic localisation in CD and more extensive disease in UC (pancolitis) were associated with a higher risk of surgery in our IBD Unit. Awareness about factors associated with unfavourable outcome allows these patients to be treated more appropriately.1

Reference

1. Solina G, Mandalà S, La Barbera C, et al. Current management of intestinal bowel disease: the role of surgery. Updates Surg 2016;68:13–23. doi:10.1007/s13304-016-0361-4