P727 Change in Crohn's disease behavior in a prospective European population-based inception cohort – the ECCO-EpiCom cohort

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Abstract

Background: Crohn's disease (CD) is a progressive disease that over time can lead to the development of complications such as strictures or internal penetrating disease that will ultimately lead to surgery. Only few population-based studies from the biological era and widespread use of immunodulators have investigated the change in disease behaviour and subsequent risk of surgery in CD.

Methods: The EpiCom-cohort is a population-based cohort of unselected patients with inflammatory bowel disease diagnosed in 2010 in Eastern and Western European centres. Patients were followed prospectively for five years and clinical data were captured throughout the follow-up period and entered in a validated web-based database. Disease behaviour as defined according the Montreal classification as B1: non-stricturing, non-penetrating, B2: stricturing; B3: penetrating based on endoscopy, cross-sectional imaging or surgery. The risk of changing behaviour from B1 to B2 or B3 as well as the risk of surgical resection was analysed by Cox regression analyses using the proportional hazard assumption including multiple covariates (age, gender, disease location, diagnostic delay, smoking status, change in behaviour, geographic region, and early treatment with biologics).

Results: The EpiCom-cohort is a population-based cohort of unselected patients with inflammatory bowel disease diagnosed in 2010 in Eastern and Western European centres. Patients were followed prospectively for five years and clinical data were captured throughout the follow-up period and entered in a validated web-based database. Disease behaviour as defined according the Montreal classification as B1: non-stricturing, non-penetrating, B2: stricturing; B3: penetrating based on endoscopy, cross-sectional imaging or surgery. The risk of changing behaviour from B1 to B2 or B3 as well as the risk of surgical resection was analysed by Cox regression analyses using the proportional hazard assumption including multiple covariates (age, gender, disease location, diagnostic delay, smoking status, change in behaviour, geographic region and treatment with biologics within 6 months from diagnosis).

Conclusions: In this European population-based inception cohort of unselected CD patients 14% of patients progressed to B2 or B3 after five years of follow-up. The risk of surgery was increased in patients with B1 who progressed to B2/B3. No clinical predictors for progression in behaviour including smoking and treatment with biological therapy could be identified.

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