DOP042 Bowel damage and its correlation with the disability index in patients with recently diagnosed Crohn´s disease
Authors: Arebi N , Fadra A , Revés J , Burisch J , Madsen G R , Buisson A , Bonnet-Dodel M , Vieujean S , Monin L , Cravo M , Duricova D , Ellul P , Kaimakliotis I , Sebastian S , Ordas I , Rodríguez-Lago I , Mocanu I , Hernandez V , Nachury M , Fumery M , Goldis A , Pedersen N , Conceição D , Barberio B , Guedes A , Ribeiro R , Ungaro R , Mary J Y , Bigot N , Lambert J , Colombel J F , Torres J ,   CROCO Study Group
Published: January 2025

Abstract

Background
Crohn’s disease (CD) progression manifests as bowel damage (BD) and disability; prevention of both is a long-term treatment target in CD. However, the longitudinal characterization of BD and disability in early CD patients remains limited.

Methods
The Crohn´s Disease Cohort (CROCO) is a multicentre, European cohort study of recently diagnosed CD patients (&lt;12 months following diagnosis) designed to prospectively characterize BD progression and disability. At one year following diagnosis (Y1), BD progression was evaluated using the Lemann Index (LI). Magnetic resonance enterography was completed by all patients, with additional endoscopy and/or pelvic MRI based on disease location. Absence of BD was defined as a LI=0, and any presence of bowel damage was indicated by LI&gt;0. Disability was assessed using the validated IBD-disability index (IBD-DI). We report the LI and its association with prognostic disease features and with IBD-DI at Y1.

Results
Among 394 included patients, 277 completed Y1 visit; LI could be calculated in 176 [60% male, median age at diagnosis 36.5Y (IQR 25-50)]. Most patients (92%) had ileal or ileocolonic involvement, 68% had inflammatory phenotype, and 11% had perianal disease at diagnosis. At inclusion, 6.2% had undergone surgery (5.1% intestinal and 1.1% perianal). Within the 1st year of disease 66% started advanced therapy, mostly Anti-TNF (59%). By Y1, 68% of the patients exhibited some degree of BD (LI&gt;0), yet the median LI at Y1 was low [0.6 (IQR 0-1.8)]. Univariate analysis revealed an association between the presence of any BD at Y1 and disease location (L2 vs L1 OR: 0.37, 95% CI 0.11-1.22, and L3 vs L1 OR 0.59, 95% CI 0.29-1.18, p= 0.044), disease behaviour (B2/B3 vs B1 OR 8.35, 95% CI 3.11-22.38 p&lt;0.01), and steroids (OR 0.48, 95% CI 0.24-0.97), p= 0.036). In a multivariate logistic model, only disease behaviour at Y1 was significantly associated with any BD (B2/B3 vs B1, aOR 7.61, 95% CI 2.79-20.71)-Table 1. The median IBD-DI in those who completed BD assessment at Y1 was 19.6 [10.4;35.7]; 29% of patients had moderate to severe disability (IBD-DI&gt; 35). No association was observed between LI and IBD-DI at Y1 (OR 0.99, 95%CI 0.97-1.02, p=0.60) and there were no differences in the median LI across disability categories. Fig1 shows the correlation between LI and IBD-DI at Y1.

Conclusion
In a cohort of newly diagnosed CD patients, approximately one-third exhibited no BD as per the LI evaluation. For those presenting with any degree of BD, the global LI remained low. Complicated disease behaviour was the only factor associated with BD. No association was found with disability assessed by the IBD-DI. Prospective follow-up will determine factors underlying BD variation over time.