P51 Predictive factors of surgery in crohn's disease. (19th June 2022)

• Record Type: Journal Article
• Authors: Nacer, Sara; Haddad, Fouad; Tahiri, Mohamed; Hliwa, Wafaa; Badre, Wafaa; Choukri, El Mehdi; Jai, Saad Rifki; Erguibi, Driss; Boufettal, Rachid; Chehab, Farid
• Is Part Of: Gut. Volume 71(2022)Supplement 1
• Page Start: A64
• Page End: A65
• Publication Date: 2022-06-19
• Subjects: Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2022-BSG.111
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Introduction: Crohn's disease (CD) is a chronic inflammatory bowel disease that can affect any part of the gastro- intestinal tract. The natural history of CD is difficult to predict. In some patients, the disease can be managed satisfactorily by medical therapy, while others develop structural complications and require repeated surgery. This study aimed to assess risk factors for surgery in patients with CD Methods: This was a retrospective descriptive and analytic single center study including all patients with established CD was carried out at tertiary university hospital from 2014 to 2021. Surgical interventions for perianal disease were excluded from the study. Independent risk factors for surgery were analyzed. Results: Of all 229 patients with CD, 31% underwent surgery. At the time of diagnosis, age was between 17 and 40 years in 59% patients. The localization of CD was ileal (L1), colonic (L2) and ileocolonic (L3) in respectively 9.6%, 19.2% and 64.6%. The disease phenotype was inflammatory (B1) in 33, 6%, structuring (B2) in 39, 3%, and penetrating (B3) in 27, 1%. Anoperineal manifestations were noted in 39, 3% of patients. The median age at surgery was 21.5 years. The median duration from diagnosis to surgery was 38 months. Emergency surgeries were required in 31.9% Indication for surgery was fistulas (70.8%), intraabdominal abscesses (18, 84%), intestinal stenosis (8, 70%) and intestinal perforation (2, 90%). The ileocecal resection was the most frequently performed resection (50, 70%) ( table 1 ). Procedures resulting in stoma accounted for (21, 60%) Risk factors for surgery were diagnosis before the age of 40 years (p=0.008), involvement of the terminal ileum (p< 0.001), stricturing disease (p< 0.001), penetrating disease (p< 0.001), male gender (p=0, 004) and smoking habit (p=0.009) Family history of CD (p= 0, 24), perianal disease (p=0.57) and the need for systemic steroids (p=0, 08) did not influence the risk of surgery significantly. Conclusion: Almost one-third of patients require surgery at a median of 3 years after onset of diagnosis. Stricturing, penetrating disease and smoking habits are identified as high risks factors predictive of surgery in patients with CD.