Background Crohn’s Disease patients (CD) with early complicated behaviour (stenosis and/or fistula) are thought to have a more severe long-term disease course. To address this question, we focused on ileal CD that requires early intestinal resection after diagnosis. We aimed to assess the impact of the time to surgery from diagnosis on the risk of severe disease course in patients with ileal CD undergoing a primary ileocecal resection (ICR) or ileal resection (IR). Methods All CD patients who underwent ICR or IR between January 2001 and December 2015 and followed in two Inflammatory Bowel Disease (IBD) tertiary centres in France were included. Data were retrieved using dedicated IBD database and patients’ medical records. Early resection was defined as a surgery performed within 6 months after diagnosis. Two control groups with patients who underwent the first surgery between 6 months and 2 years and between 2 and 5 years after diagnosis were enrolled. The primary outcome was second intestinal resection. Secondary outcomes included the need for biologic treatments after initial intestinal surgery. Patients were followed from the date of first surgery until September 2022. Kaplan Meier survival analysis and log-rank test were used to estimate the survival without second intestinal resection and biologic initiation according to the time of first intestinal resection to diagnosis. Results Among 404 patients who underwent ICR or IR within 5 years after diagnosis, 130 (32.2%) patients had undergone surgery within 6 months after diagnosis (Group A), 138 (34.2%) patients between 6 months and 2 years (Group B) and 136 (33.7%) patients between 2 and 5 years (Group C). Clinical data are shown in Table 1. The cumulative risk of a second ICR or IR ten years after the first surgery was 25.2% (95% CI 12.5 - 40.2) in group A, 16.6% (5.1 - 33.9) in group B and 22.8% (9.8 – 39.1) in group C, without statistically significant difference (p = 0.25) (Figure 1). The risk of biological exposure after the first surgery was not significantly different in the three groups (p = 0.12) (Figure 2). The cumulative risk to start a biologic therapy at ten years was 46.2% (35.0 – 56.6) in group A, 39.0% (26.2 – 51.5) in group B and 48.0% (36.3 – 58.8) in group C. Conclusion In a bicentric cohort with long-term follow-up, intestinal resection within 6 months of CD diagnosis was not associated with an increased risk of second surgery as compared to patients with primary ICR/IR later after diagnosis. Furthermore, patients with early intestinal resection did not need more biological therapies after the first surgery. These data suggest that early intestinal resection in CD is not a predictor of poor long-term prognosis compared to late resection.

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Inflammatory bowel diseases (IBD) are associated with an increased risk of various complications related to human papilloma virus (HPV), including cervical neoplasia and anal squamous cell carcinomas. 1,2 This risk may be mainly driven by thiopurines, as it promotes primarily viral infections. While thiopurines have been associated with an increased risk of skin warts in patients with IBD followed in tertiary care centers, 3 the risk of genital warts had never been assessed in a population-based cohort of patients with IBD. Although a benign disease, the burden of genital warts is substantial with a physical and psychological impact. Gastroenterologists are marginally involved in the therapeutic management, as local treatments are prescribed in first line by the general practitioner or dermatologist.HPV immunization through vaccination is available since 2006 and is effective against HPV serotypes 6 and 11, which are mostly involved in the development of genital warts. Finally, the real burden remains difficult to assess due to underreporting by patients and doctors. 4 In the current issue of the United European Gastroenterology Journal, Elmahdi et al. assessed the risk of developing genital warts in patients with IBD using a nationwide population-based cohort from 1996 to 2018. 5 Using Danish registries, 49,163 IBD patients were matched by age, sex, and HPV immunization status to 491,665 individuals. They observed a 33% increased risk of genital warts in patients with IBD compared to the matched population (HR,).Compared to the general population, the excess of risk related to IBD was mainly observed in women (HR,).Patients with Crohn's disease were at increased risk compared to patients with ulcerative colitis after adjusting for treatment (HR, 1.13 [95% CI 1.01-1.27]), and patients exposed to thiopurines were particularly at excess risk (HR,). Some limitations need to be acknowledged. Treatment exposure was based on