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P696 Long-term prognosis and predictive factors for surgical treatment of intestinal lesions in patients with Behcet’s disease

T. Chohno*1, K. Watanabe1, T. Minagawa1, R. Kuwahara1, Y. Horio1, H. Sasaki1, T. Bando1, M. Uchino1, H. Ikeuchi1

1Hyogo College of Medicine, Inflammatory Bowel Disease, Nishinomiya, Hyogo, Japan

Background

Behcet’s disease with intestinal lesions, known as intestinal Behcet’s disease (Int BD), is a manifestation of the disease that is often treated with immunosuppressive therapy, such as anti-tumour necrosis factor (TNF)α agents. However, some with Int BD cases are refractory to medical treatment and require surgery, though predictive factors indicating that have yet to be established. The aim of this study was to evaluate predictive factors for surgery (in principle, hand-sewn end-to-end anastomosis) as well as long-term prognosis in patients with Int BD.

Methods

Int BD was diagnosed according to the Japanese diagnostic criteria for BD. This single-centre retrospective study was conducted at our referral institution for IBD surgery between January 2000 and December 2017. Patients who underwent an emergency operation due to perforation prior to a definitive diagnosis were excluded.

Results

A total of 42 (22 males) patients with Int BD were included. Their median age was 39 years (range 11–76) and the duration of disease was 4.3 years (0.1–16.1). Lesion location was ileocaecal in 26 (61.9%), ileum and colon in 10 (23.8%), and colon in 6 (14.3%) patients. Five (11.9%) were also complicated with oesophageal lesions. For medical treatment, 5-aminosalicylates were given to 31 (73.8%), corticosteroids to 30 (71.4%), anti-TNFα agents to 26 (61.9%), immunomodulators to 22 (52.4%), and colchicine was given to 20 (47.6%) patients. An intestinal resection was performed in 25 (59.5%) cases. The median time from initiation of medical treatment to surgery was 19.6 months (2.4–192.9 months). The cumulative operation rate after obtaining a definitive diagnosis was 19.1% at 1 year, 23.8% at 3 years, and 28.9% at 5 years. Postoperative complications were surgical site infection in 11 (26.2%) patients, including 2 with an intraabdominal abscess and 1 with a ruptured suture, and bowel obstruction was seen in 3 (7.1%). Intestinal lesion recurrence was confirmed in 13 patients, of whom 8 underwent a re-operation. The cumulative re-operation rate after the first surgery was 8.6% at 1 year, 23.0% at 3 years, and 31.5% at 5 years. Predictive factors for surgery shown by univariate analysis were corticosteroids administration (OR, 4.6; p = 0.03), colchicine administration (OR, 3.6; p = 0.05), higher CRP (OR, 1.2; p = 0.01), lower haemoglobin (OR, 0.8; p = 0.16), and non-administration of an anti-TNFα agent (OR, 0.2; p = 0.04), while non-administration of an anti-TNFα agent (OR, 0.1; 95% CI, 0.01–0.61; p = 0.04) was the only predictive factor for surgery in multi-variate analysis.

Conclusion

Surgery and a re-operation are sometimes needed during the clinical course of Int BD. Administration of an anti-TNFα agent with appropriate timing may be effective to avoid surgery.