P90 Post-operative Crohn’s disease recurrence in glasgow – how common is it and does deprivation matter?

Introduction 50% of patients with Crohn’s Disease (CD) will have surgery within the first 10 years, with 35% requiring additional surgery. The REMIND cohort linked male gender, smoking and previous resection to recurrence.1 The link between CD and deprivation is debated2, and its influence on recurrence is unknown. We aimed to define our local post-operative CD population, highlighting recurrence rates. Methods CD resections between 2008–2014 were identified from NHS Greater Glasgow & Clyde Pathology Archive. Data including gender, age at diagnosis and resection, Montreal Classification and smoking status was obtained from Electronic Patient Records. Scottish Index of Multiple Deprivation (SIMD) score was determined by postcode and was ranked 1–5 (most to least deprived). A minimum of 5 years of follow up data was collected. Type of recurrence was recorded as: 1) clinical recurrence - symptom flare requiring course of steroids or inpatient admission; 2) biochemical recurrence - faecal calprotectin >250µg/l; 3) endoscopic recurrence; or 4) surgical recurrence – the need for further CD-related surgery. Results 304 patients (59.5% female) were included. Median age at diagnosis was 29 (range 3–82 years) and at resection was 43 (range 17–85 years). 82.9% had terminal ileal, colonic, or ileocolonic involvement. Upper GI and perianal disease occurred in 17.1% and 12.8% respectively. 94% had a stricturing or penetrating phenotype. 52.9% of patients were never-smokers, 16.5% were ex-smokers and 30.6% were current smokers. 33.6% patients had a SIMD score of 1. 47% of patients had clinical recurrence and 48.7% had biochemical recurrence with 49 patients 16.1% requiring further surgery for Crohn’s disease. There were significant associations between younger age at diagnosis/resection, male sex, current smoking and biochemical, surgical and clinical recurrence respectively. There was no significant association between SIMD score and recurrence of any type. Conclusions Our data suggests rates of post-operative recurrence in line with existing published data. Risk factors for this are similar to those identified in the REMIND study1, with younger age at diagnosis/resection, male sex and smoking all associated with higher rate of recurrence. Our data suggests deprivation does not influence recurrence rates. However more work is needed to validate this in larger, prospective cohorts. References Auzolle, et al. Male gender, active smoking and previous intestinal resection are risk factors for post-operative endoscopic recurrence in Crohn’s disease: results from a prospective cohort study. Aliment Pharmacol Ther 2018 Nov;48(9):924–932 Wardle, et al. Literature review: impacts of socioeconomic status on the risk of inflammatory bowel disease and its outcomes. Bottom of Form European Journal of Gastroenterology & Hepatology 29(8):879–884.

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