684 Crohn's Disease and Risk of Surgery Based on Disease Location and Phenotype

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INTRODUCTION: Crohn's disease (CD) is a chronic inflammatory disease that can affect any segment of gastrointestinal tract. Over 50% of patients develop complications like strictures or fistula formation and past studies report 50% of Crohn's disease patients require surgery within ten years from disease diagnosis. We aim in this study to determine the risk of surgery in Crohn's disease based on disease location and phenotype. METHODS: A retrospective study was conducted evaluating CD patients on anti TNF agents seen at the University of Kansas Medical Center from data inceptions until May, 2018. Patients were stratified by disease location (ileum, colon, ileocolon, or upper GI tract) as well as phenotype (stricturing, fistulizing, luminal or mixed patterns). The primary outcome was the need of surgery based on phenotype and disease location. The secondary outcome was the time to start anti TNF therapy in each category based on disease location and phenotype. RESULTS: Data from 229 patients with CD was analyzed. From which, 128 underwent surgery. Our analysis showed that Patients with the fistulizing type had the highest rate of surgery with 51/62 patients (82% P < 0.0001) with (mean = 5.69 ± 9.3 years to start anti TNF) and patients with the luminal subtype had the lowest rate of surgery with 26/89 patients (29%, P < 0.0001) with (mean = 3.77 ± 8.88 years to start anti TNF) in comparison to patients with other subtypes stricturing, stricturing + fistulizing, stricturing + luminal, fistulizing + luminal or Stricturing + fistulizing + luminal who had 31/50 (62%, P = 0.33, mean = 7.02 ± 8.89 years), 11/15 (73%, P = 0.16 mean = 10.9 ± 13.2), 2/3 (66% P = 1, mean = 0.33 ± 0.58), 6/9 (66%, P = 0.74 mean = 4.89 ± 6.), and 1/1 (100% P = 1, mean = 2) respectively. Regarding the location of Crohn's disease, patients with ileocolonic involvement had the highest rate of surgery with 64.2% and with a mean of 6.15 ± 9.95 years to start anti TNF, Whereas patients with only colonic involvement have the lowest rate of surgery of 37.5% with a mean of 4.33 ± 8.41 years to start anti TNF. Patients with the disease in other locations; ileal and upper GI had 39% rate of surgery (with a mean of 2.64 ± 4.25 years to start anti TNF) and 61.9% % rate of surgery (with a mean of 8.43 ± 11.74 years to start anti TNF) respectively. CONCLUSION: Patients with CD with fistulizing phenotype and ileocolonic location are at the highest risk for surgery, whereas patients with luminal phenotype and colonic location are at the lowest risk for surgery.