P-190 High Total Visceral Fat Volume Is Associated with Poor Response of Medication Step-up in Symptomatic Crohn's Disease Patients

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Abstract

Background:

Visceral adipose tissue accumulation is associated with poor outcome in patients with Crohn's disease (CD). However, little is known on the correlation between total visceral fat volume and clinical outcome in CD patients. The aim of current study was to evaluate clinical significance of total visceral fat volume in patients with symptomatic CD.

Methods:

Patients who visited the emergency room at CHA Bundang medical center after diagnosis of CD and underwent abdominal computed tomography (CT) for any indication during the period from April 2010 to April 2016 were retrospectively included in the study. Total visceral fat volume was calculated from non-contrast phase of CT, using 3D workstation (Advantage Workstation 4.3; GE Healthcare) and was adjusted by body surface area (BSA). Clinical outcomes including hospital stay, operation, medication step-up, and response of step-up therapy were analyzed.

Results:

A total of 52 CD patients were enrolled (35 [67.3%] males; median age 30 [20–81] yr). Median disease duration was 1376 (0–9024) days. Eight (15.4%) patients underwent bowel resection. Median duration of hospital stay was 8 (2–62) days. Medication step-up was done in 36 (69.2%) patients (immune modulators in 20 [38.5%], anti-TNF agents in 5 [9.6%], and both in 10 [19.2%] patients, respectively). Clinical remission was achieved in 21 (58.3%) patients after medication step-up. Total visceral fat volume per BSA was significantly smaller in patients who underwent operation than in patients who did not (1.45 versus 1.74 cm3/m2, respectively; P = 0.031). There was no significant difference of total visceral fat volume between patients who did medication step-up and who did not (1.65 versus 1.55 cm3/m2, respectively; P = 0.411). However, Total visceral fat volume of those who did not show appropriate response to medication step-up was significantly higher than who achieved clinical remission (1.87 versus 1.50 cm3/m2, respectively; P = 0.002).

Conclusions:

Higher total visceral fat volume was related with poorer treatment response of medication step-up in patients with symptomatic CD while smaller total visceral fat volume was associated with more frequent immediate bowel surgery.

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