Background Crohn’s disease (CD) is a lifelong disease. Knowing the natural history is essential to understand the evolution of the illness, assess the impact of different therapeutic strategies, identify poor prognostic factors and provide patients with understandable information who help them in decision-making. One of the most relevant features in natural history of Crohn’s Disease (CD) are surgery requirements. Methods We performed a retrospective study that includes all patients with a definitive diagnosis (DD) of CD in the Navarra Incident Cohort (which includes all patients diagnosed between 2001 and 2003 in Navarra, Spain). Our objectives were to analyze the cumulative incidence of surgical resection and to identify predictive factors for surgery. Results We included 94 patients with DD of CD (L1 46.8% / L2 17% / L3 36.2%) 49 were men, median age at diagnosis of 34 years (7-75) and with a median follow-up of 15.6 years. At the end of the follow-up, 42.5% of the patients had undergone surgery, 33 (35%) intestinal resection, 7 (7.5%) surgery for perianal disease (PAD) and three (3%) for both reasons. In total 59 interventions were performed, 19 of them for PAD. The cumulative incidence of intestinal resection in our series was 5.3% at diagnosis, 8.5% at one year, 22.4% at 5 years, 29.9% at 10 years, 44.6% at 15 years, and 68.3% at the end of the follow-up (fig A). In 82% of cases a single resection was performed and in 6 patients 2 resections were performed. The surgery was elective in 80% of the cases. Before the intervention, all had received corticosteroids or 5-ASA, 25% (8) immunomodulators and 21% (7) biological agents. The most frequent indication was symptomatic stenosis (45%) followed by inflammatory abscess (25%). In the univariate analysis, age at diagnosis, sex, L4 involvement, extraintestinal manifestations, and Harvey-Bradshaw index were not associated to the probability of intestinal resection. Disease location and behaviour were associated with more probability of resection (fig B and C). In the multivariate analysis, penetrating behaviour (B3 vs B1) was an independent risk factor associated with resective surgery (HR 14.48; 95% CI 4.17-50.3; p <0.001) while ileocolonic disease (L3) was a protective factor compared with ileal location (L1) (HR 0.32; 95% CI 0.12-0.84; p = 0.02) Conclusion - In our cohort 5.3% of patients require intestinal resection at diagnosis and the cumulative incidence at 15 years of 45% - Penetrating behavior was an independent risk factor for surgery and ileocolonic location a protective factor

Background Crohn’s Disease (CD), ulcerative colitis (UC) and IBD unclassified (IBD-U) may affect the health-related quality of life (HRQoL). We evaluated HRQoL and patient’s disease course perception in the Navarra Incident Cohort (includes all new diagnosis from 2001-2003 in Navarra, Spain) Methods All patients were invited to complete two HRQoL questionnaires: the generic EuroQoL-5 dimensions (EQ-5D-3L) and the Inflammatory Bowel Disease Questionnaire (IBDQ-36). Patients’ disease course perception was evaluated using the four disease curves from the IBSEN cohort Results From 285 patients initially diagnosed, we obtained 158 questionnaires (72% response rate after excluding deaths and lost to follow-up); 103 UC, 50 CD and 5 IBD-U, 40% women and median age 52 (22-84). Most patients were in remission (99% UC/ 88% CD/ 100% IBD-U). In EQ-5D-3L, 55% answered not having, 41% having some and 4% having significant impairment in at least one dimension. “Pain/discomfort” and “anxiety/depression” were the most affected dimensions with no differences by diagnosis. However, 91% of UC and 85% of CD patients considered their health status to be the same or better compared to the previous year. Median IBDQ-36 score in UC was significantly higher than CD (227 vs 212, p=0.04). No differences were found in partial median scores in bowel symptoms and social impairment with significantly higher median scores in UC compared to CD in systemic symptoms, emotional function and functional impairment. Similar results between UC and IBD-U were obtained (table1). Regarding disease course, 67% of UC and 54% of CD patients chose to have a progressive decrease in the intensity of symptoms since onset (p=0.2). Significantly more CD that UC patients considered a disease with recurrent flares of activity (40% vs 23%, p=0.015). The increase in symptoms throughout the evolution was the pattern chosen by 8% of UC and 4% of CD patients, while only 2% in each disease defined its situation as persistent chronic activity throughout the follow-up. Conclusion - Patients have a significant impact in their HRQoL despite being in remission - Systemic symptoms, emotional function and functional impairment were more affected in CD patients. - Most patients considered their disease as a progressive decrease in the intensity of symptoms with significantly more CD patients considered having recurrent flares of activity.