P418 Predictive factors of surgery in the course of Crohn’s disease

Abstract

Surgical treatment in Crohn’s disease (CD) is unavoidable in about 70% of patients during the course of the disease. Early intensive therapy is necessary in these patients to reduce the risk of bowel damage leading to surgery like strictures or fistulae. The aim of our study was to assess risk factors for surgery during the course of CD. Retrospective analytic study, collecting all patients diagnosed with Crohn’s disease in our department from January 2007 to June 2017. Surgical intervention for perianal disease was excluded from the study. Independent risk factors of surgery were evaluated by univariate and multivariate analysis. One hundred and twelve CD patients were enrolled with a mean age of 42 years old and a sex ratio (W/M) of 0.96. In total, 41 patients (36.6%) underwent surgery after a mean follow-up of 14.6 months. Thirty patients (73%) had ileal disease, 6 (15%) had colonic disease, and five (12%) had ileo-colonic disease. Indications for surgical treatment were: bowel obstruction in 26 patients, intraabdominal abscess with ileal disease in 9 patients, and acute severe colitis in 6 cases. The presence of obstructed bowel symptoms (p = 0.03), complicated disease at diagnosis (intestinal stenosis, fistula) (p = 0.001), ileal CD affecting >35 cm in extent at diagnosis (p = 0.04), young age (< 30 years) at diagnosis (p = 0.012), and Crohn’s disease activity index (CDAI) > 250 (p = 0.03) were independent predictive risk factors for subsequent surgery in CD. Surgical treatment is a common outcome in luminal CD. Independent risk factors for surgery during the course of the disease were: history of obstructed bowel signs, complicated behaviour at diagnosis, CD involving more than 35 cm of the ileum at diagnosis, young age at diagnosis (<30 years), and CDAI >250.