P070 Stricturing Crohn's disease: Can we predict need for surgery at first hospitalization?

Abstract

BACKGROUND: Patients with stricturing Crohn’s disease (CD) are frequently hospitalized and a significant percentage requires surgery in the course of the disease. We aimed to assess if there are any predictors of surgical management by the time of the first admission to hospital with obstructed bowel symptoms. METHODS: Retrospective unicentric study. Patients over 18 years old, with structuring ileal or ileocolonic involvement, with at least one hospitalization and a minimum follow up of 1 year were included. Excluded patients with penetrating disease, those who had their first hospitalization before anti-TNF agents became available in our center and those without appropriate records. Several clinical, analytical and radiological variables were assessed. Statistical analysis was performed using SPSS v23.0. RESULTS: Included 43 patients of which 53.5% underwent surgery to treat structuring disease. Patients had a mean age of 43.3 ± 10.8 years, 53.5% were females and the median follow up time was 11.0 ± 7.0 years. Comparing patients with and without need for surgery, no significant differences were found between groups regarding age at diagnosis, presence of perianal disease, family history and smoking habits, however females were more frequently submitted to surgery (73.9% vs 30.0%, P = 0.004) as well as patients who already had a structuring behavior at diagnosis when compared with those with inflammatory behavior at diagnosis (65.6% vs 18.2%, P = 0.006). At the first hospitalization, patients with need for surgery were less frequently under anti-TNF (0.0% vs 20.0%, P = 0.039), presented with longer-standing obstructed bowel symptoms (3.0 ± 1.5 days vs 1.0 ± 1.0 days, P = 0.010), higher leukocytes count (12.0 ± 5.3 × 103/μL vs 9.2 ± 6.9 × 103/μL, P = 0.037) and admission computerized tomography (CT) more frequently showed proximal small bowel dilation (86.4% vs 40.0%, P = 0.002) and longer extent of small bowel involved (8.0 ± 12.0 cm vs 5.0 ± 7.0 cm, P = 0.016). Also, patients that were diagnosed by the time of the first hospitalization were more frequently submitted to surgery than those who already had a CD diagnosis (60.9% vs 39.1%, P = 0.043). CONCLUSION(S): Females, patients with structuring behavior from diagnosis and those diagnosed in the first hospitalization were more frequently submitted to surgery. Small bowel dilation and extent of small bowel involved in admission CT, leukocyte count and duration of obstructed bowel symptoms at the first admission were also predictors of need for surgery. Anti-TNF therapy before the first admission seems to reduce need for surgery in this group of patients.