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P744 A significant decline in surgical resections during childhood with increased prevalence of anti-TNF therapy in patients with paediatric inflammatory bowel disease

J. J. Ashton*1,2, F. Borca3, E. Mossotto2,3, T. Coelho1, A. Batra1, N. Afzal1, H. Phan3, M. Stanton1, S. Ennis2, R. M. Beattie1

1Southampton Children's Hospital, Department of Paediatric Surgery, Southampton, UK, 2University Hospital Southampton, Department of Human Genetics and Genomic Medicine, Southampton, UK, 3University Hospital Southampton, NIHR Southampton Biomedical Research Centre, Southampton, UK

Background

The use of anti-tumour necrosis factor-α (anti-TNF) therapy has seen a rise over the last 15 years in paediatric inflammatory bowel disease (PIBD). Whether this has translated into preventing complications and avoiding surgery in childhood is less certain. Data from the Wessex PIBD cohort were analysed to assess for trends in anti-TNF therapy and surgical intervention.

Methods

All patients diagnosed with PIBD within Wessex from 1997–2017 were eligible. Prevalence of anti-TNF and yearly surgery rates (resection and perianal) during childhood ( < 18 years of age) were analysed by Pearson’s correlation, multiple linear regression and Fisher exact test.

Results

825 children were included in the analysis (498 Crohn’s disease, 272 ulcerative colitis, 55 IBDU), mean age at diagnosis 13.62 years (1.59-17.64 years), 327 (39.6%) female. The prevalence of patients treated with anti-TNF therapy increased from 5.05% to 27.11% (2007–17), p = 0.0001. Surgical resection rate per year fell significantly (7.07% to 1.46%, p = 0.001), driven by a decrease in resections for CD (8.9% to 2.3%, p = 0.001). There was no reduction in resection rate for UC (p = 0.29) (Figure 1).

The time from diagnosis to resection increased from 1.57 to 5.11 years, p = 0.002. Mean age at surgery was unchanged indicating patients undergoing surgery during childhood were younger at diagnosis (2007–2011= 13.05 years, 2013–2017=11.76 years, p = 0.014). There was no change in the rate of perianal surgery (Table 1).

The incidence of surgery in those treated (16.1%) or untreated (12.2%) with anti-TNF agents was no different (p = 0.25). Sub-analysis of patients started on early anti-TNF therapy ( < 3 years post diagnosis) vs. late revealed a modestly significant reduction in the number patients undergoing surgical resection (11.6% and 28.6%, respectively, p = 0.047). A multiple linear regression model projected anti-TNF prevalence as the only significant predictor of surgical resection rate (p = 0.011).

Conclusion

There is an increase in the number of patients treated with anti-TNF therapy alongside a statistically significant decrease in the surgical resection rate. Despite this, children diagnosed at younger ages were still undergoing surgery during childhood. These data suggest that anti-TNF therapy may modify the natural history of IBD, reducing the need for surgical intervention.