P627 Variables associated with evolution to moderate to severe Crohn’s disease at two reference centers in Salvador, Bahia, Brazil

Abstract

Background The identification of variables associated with evolution to moderate to severe disease is essential for the therapeutic management of patients with Crohn’s disease (CD). However, studies on this topic are scarce in developing countries. The main objective of this study is to determine the variables associated with hospitalization in patients with CD. The secondary objective is to identify variables associated with surgery, intestinal resection, rehospitalization, surgical recurrence and use of immunobiological therapy. Methods Cross-sectional study with a retrospective component that involved two reference centers for inflammatory bowel diseases in the public health system. Data were collected through a specific questionnaire and review of medical records in the period 2019 to 2021. The association between variables was evaluated through Chi-Square test and multivariate binary logistic regression. Results Were included 220 patients, 50.9% female. The most common findings were: age at diagnosis between 17 and 40 years (67.7%), colonic location (45.0%) and no stricturing no penetrating behavior (75.9%). Perianal disease was observed in 27.7% and involvement of the upper gastrointestinal (GI) in 16.1% (Table 1). 174 (79.1%) patients were hospitalized, 109 (49.5%) underwent surgery, being 50 (22.7%) bowel resection. 106 (60.9%) were readmitted, 13 (26.0%) presented surgical recurrence and 128 (58.2%) used immunobiologicals. Perianal disease was the only variable associated with hospitalization (p=0.012). Stricturing or penetrating behavior (p<0.001) and perianal disease (p<0.001) were associated with surgery. Regarding intestinal resection, ileal or ileocolon location (p=0.044) and stricturing or penetrating behavior (p<0.001) were variables associated. The use of corticosteroids in the first flare (p<0.001) was associated with rehospitalization, and postoperative complications (p=0.029) with surgical recurrence. Age at diagnosis below 40 years (p=0.004), upper GI involvement (p=0.040) and perianal disease (p<0.001) were associated with the use of immunobiologicals (Table 2). Conclusion This is a pioneer study in Brazil on variables associated with evolution to moderate to severe CD. Perianal disease and stricturing or penetrating behavior were associated with more than one outcome. Age at diagnosis below 40 years, ileal and ileo-colic location, upper GI involvement, use of corticosteroids in the first flare and postoperative complications were also variables found. These data are similar to those found in countries with a high prevalence of the disease1. Reference 1. Torres J et al. Predicting Outcomes to Optimize Disease Management in Inflammatory Bowel Diseases. J Crohns Colitis. 2016;10(12):1385–1394.