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P471 Predictors of bowel damage in long term progression of Crohn’s disease

Fernandez Clotet, A.(1);Panes, J.(1);Ricart, E.(1);Castro Poceiro, J.(1);Masamunt, M.C.(1);Rodríguez, S.(2);Caballol, B.(1);Ordas, I.(1);Rimola, J.(2);

(1)Hospital Clinic de Barcelona, Gastroenterology department, Barcelona, Spain;(2)Hospital Clinic de Barcelona, Radiology department, Barcelona, Spain

Background

Crohn’s disease is a chronic inflammatory bowel disorder that progresses to bowel damage over time.  An image-based index, the Lémann Index, has been developed to measure the cumulative bowel damage.

AIMS: To characterize the long-term progression of bowel damage in Crohn's disease based on changes in the Lémann Index and to determine risk factors for long term progression. 

Methods

This was a single-center longitudinal cohort study. Patients who had participated in prospective studies on the accuracy of magnetic resonance imaging using endoscopy as gold standard and had a follow-up of at least 5 years were reevaluated after 5-12 years. 

Results

Seventy-two patients were included. Lémann Index increased in 38 patients (52.8%), remained unchanged in 9 patients (12.5%) and decreased in 25 patients (34.7%). Small bowel score and surgery subscale significantly increased (p=0.002 and p=0.0001), whereas fistulizing subscale significantly decreased (p=0.001). Baseline parameters associated with bowel damage progression were ileum location (p=0.026), phenotype (stricturing, fistulizing or both with p=0.007, p=0.006 and p=0.035), disease duration >10 years (p=0.019) and baseline Lémann Index stricturing score (p=0.049). No correlation was observed between bowel damage progression and baseline clinical activity, biological markers or endoscopic lesions. Need of surgery during follow-up was a major determinant of bowel damage progression (p=0.0001). Baseline stricturing Lémann Index score was associated with the risk of future surgery (p=0.02).

Conclusion

Bowel damage, assessed by the Lémann Index, progresses in half of the patients with Crohn's disease over a period of 5-12 years. The main determinants of bowel damage progression are ileum location, stricturing/fistulizing phenotype and disease duration.

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