P269 Phenotypic predictors of endoscopic recurrence after ileal resection for Crohn's disease: an NIDDK IBD Genetics Consortium prospective study

Background: Disease recurrence in patients after ileal resection of Crohn's Disease (CD) is predictable and represents an excellent model to study the mechanisms of intestinal inflammation in an at-risk population. Our aim is to investigate genomic and microbial factors associated with post-operative endoscopic recurrence (ER). Here we present preliminary phenotypic analysis of recruited subjects to a prospective NIDDK Inflammatory Bowel Disease Genetics Consortium longitudinal study. Methods: Patients with CD scheduled to undergo ileocolic resection with primary anastomosis were recruited at 6 North American research centres using a standardised protocol. Clinical data and bio specimen collection for microbiome and histological assessment was performed pre-operatively and at follow up. A Rutgeert's score of at least i2 determined endoscopic recurrence. Bivariate analysis (χ2 test) was performed using Graphpad. Results: 294 patients were enrolled up to August 2016 and 122 had at least 1 post-operative endoscopy. The overall recurrence rate in the neo-terminal ileum up to 18 months was 33.6% (n=41/122). Early ER was present in 23.7% (n=29/122) at a median 6 months. CD recurrence was not significantly associated with Montreal classification, age, gender, smoking, or previous hospitalisations. Patients with a prior history of ileal resection had a higher risk of post-operative ER (p=0.004, RR 2.6 95% CI [1.5–3.8], n=9/41 vs n=3/81). Peri operative steroids (p=0.002, RR 3.4 95% CI [1.46–8.9]), combined immune suppressants and anti-TNF agents (p=0.028) and anti-TNF monotherapy use (p=0.056, RR 1.03 95% CI [1.002–4.04]) were associated reduced likelihood of ER. Use of anti-TNF therapy post-operatively was also associated with reduced recurrence (p=0.03, RR 2.81 95% CI [1.18–7.3], 15.7%, n=6/38 vs 41.6%, n=35/84). Patients recruited in the USA were more likely to receive anti-TNF therapy prior to first post-operative endoscopy (p=0.02, RR 2 95% CI l1.4–3.6]). Early recurrence rates were higher in Canadian centres although this was not statistically significant (p=0.45 [20% vs 40%]). Conclusions: Preliminary phenotypic results showed that previous surgery predicted endoscopic post-operative recurrence, potentially indicating a more aggressive phenotype. Steroid exposure perioperatively and use of anti-TNF biologic therapy peri- and post-operatively before colonoscopy were associated with lower risk of endoscopic recurrence, validating studies which show benefit of anti-TNF in prevention of post-operative recurrence. Future studies in this population will investigate microbial and transcriptomic profiles related to disease recurrence and ongoing recruitment will further expand our cohort

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