P029 Background factors associated with the prognosis of patients with Crohn's disease: A single-center, retrospective study

Abstract

BACKGROUND: Crohn's disease (CD) is a chronic and intractable granulomatous disease. Its onset often occurs at an earlier age, with disease severity being greater in early-onset cases than in adult-onset cases. Many CD patients, mainly adults, have been treated at our hospital in Japan. However, limited studies have examined background factors that affect prognosis in Japanese patients with CD. Therefore, this study aimed to examine background factors in CD patients treated at our hospital. METHODS: According to the age of disease onset, patients were divided into those less than 17 years of age (early-onset inflammatory bowel disease [EO-IBD] and those 17 years of age and older (late-onset IBD [LO-IBD]). The primary endpoint was the cumulative surgery-free rate, and the secondary endpoint was the rate of treatment not requiring biological agents. RESULTS: We evaluated 1,148 patients with CD who visited our hospital between 1985 and October 2015. The EO-IBD and LO-IBD groups included 257 (22.4%) and 891 (77.6%) patients, respectively. We could evaluate the disease course until surgery in 1,112 patients. The numbers of patients in the EO-IBD and LO-IBD groups who underwent surgery were 158 (of 251 evaluable patients; 63%) and 496 (of 861 evaluable patients; 58%), respectively, and there was no significant difference between the groups (P = 0.13). The cumulative surgery-free rates, as determined using the Kaplan–Meier method, were 55% and 21% at 10 and 20 years, respectively, in the EO-IBD group and 51% and 26% at 10 and 20 years, respectively, in the LO-IBD group (P = 0.59). In total, 1,136 patients were treated with biological agents; the numbers of patients in the EO-IBD and LO-IBD groups were 164 (of 256 evaluable patients; 64%) and 465 (of 880 evaluable patients; 53%), respectively, and there was a significant difference between the groups (P = 0.001). The cumulative rates of treatment not requiring biological agents, as determined using the Kaplan–Meier method, were 65% and 39% at 10 and 20 years, respectively, in the EO-IBD group and 72% and 49% at 10 and 20 years, respectively, in the LO-IBD group (P = 0.03). CONCLUSION(S): The cumulative surgery-free rate was not different between the EO-IBD and LO-IBD groups, whereas the rate of treatment with biological agents was greater in the EO-IBD group than in the LO-IBD group. Thus, the severity of EO-IBD might progress faster than that of LO-IBD. This finding should be considered in the follow-up of patients.