Mo1342 A Concept Recognition Tool to Identify the Surgical Complications of Crohn's Disease in Electronic Health Records

Abstract

Background: Previous studies have shown that diagnosis of Crohn's disease (CD) in childhood is associated with a different phenotype when compared to adults (higher risk for ileocolonic disease and fibrostenotic behavior), and may be associated with a more aggressive form of disease requiring more surgery. Those diagnosed at an older age have been reported to have an increased rate of isolated colonic disease and a milder course of disease requiring less surgery. Methods: A comprehensive medical chart review was done for 571 CD patients that were followed in a tertiary referral IBD clinic. Among the parameters that were recorded for each patient at specific time intervals were parameters of disease phenotype according to the Montreal Classification (A1 diagnosed ,16, n=88, A2 diagnosed 16-40, n=287, A3 diagnosed .40, n=77) as well as having surgery. Results: The study included 452 patients that had complete data in the charts. At 6 years from diagnosis and at last follow-up (median11 years), A3 had a higher rate of isolated colonic disease than A1 but not in comparison to A2. Perianal involvement was significantly less common in A3 than A1 or A2. Complicated disease behavior (B2/B3) was similar for all three groups at both time frames. Nonetheless, at 6 years and last follow-up, IBD-related abdominal surgery rates were significantly lower for A1 vs. A2 and vs A3. Conclusions: While there are some disease location differences that emerge with increasing age of presentation (more isolated colonic disease and less perineal disease) disease behavior over time is similar regardless of age at diagnosis and surgeries were least likely in those diagnosed prior to age 16. Our study did not corroborate a more aggressive course for CD that presents in the pediatric age group. Outcomes at 6 years from diagnosis