P0345 Tailoring Crohn’s disease surveillance in clinical remission: new insights from the Lewis score
A I Ferreira, T Lima Capela, S Xavier, C Arieira, B Rosa, J CotterAbstract
Background
Optimal thresholds for Lewis score in the surveillance of patients with known Crohn’s disease (CD) in clinical remission remain uncertain. The aim of this study was to evaluate predictive factors of clinical exacerbation in patients with small bowel inflammatory-type CD in clinical remission, focusing on the yield of the Lewis score.
Methods
Retrospective, unicentric cohort study including adult patients with known small bowel inflammatory-type, non-stricturing and non-penetrating CD, in clinical remission, who were submitted to small bowel capsule endoscopy for evaluation of mucosal healing. Clinical exacerbation was defined as the need for corticosteroid administration, biological/immunomodulator treatment initiation, intensification or switch, intestinal surgery, or CD-related hospitalization, with a minimum follow-up time of 24 months.
Results
A total of 63 patients were included, and clinical exacerbation occurred in 18 patients (28.6%), with 8 patients requiring oral corticosteroid administration (12.7%), 12 needing biological/immunomodulator treatment initiation or switch (19.0%), and 2 needing both (3.2%). An age ≤33 years and a Lewis score >225 were found to be independent predictive factors of clinical exacerbation (OR 7.145, p=0.028 and OR 12.585, p=0.005, respectively). Patients who were not in biochemical remission were 14 times more likely to have a clinical exacerbation during follow-up (83.3% vs 42.2%, p=0.003). Furthermore, patients who were not in biochemical remission and who had a Lewis score >225 were 16 times more likely to have a clinical exacerbation (66.7% vs 13.3%, p<0.001). Patients with a Lewis score >225 had an overall risk for clinical exacerbation of 59.1%, compared to 12.2% in those with a Lewis score ≤225 (p<0.001). Additionally, patients with a Lewis score >225 had a shorter period of time free from clinical exacerbation (32±5 vs 80±5 months, χ2=22.414, p<0.001) (figure 1).
Conclusion
Clinical exacerbation occurred in almost one third of patients with small bowel inflammatory-type CD in clinical remission. An age ≤33 years and a Lewis score >225 were independent predictive factors of clinical exacerbation. The absence of biochemical remission was also associated with clinical exacerbation. A Lewis score >225 was the best threshold to predict clinical exacerbation and shorter period of time free from clinical exacerbation. Therefore, in small bowel CD patients with a Lewis score <225, a wait and watch therapeutic strategy can be applied, since the risk of clinical exacerbation for a minimum 24-month follow-up period is low. However, those with a Lewis score >225 should be considered for therapeutic intensification, especially if younger, in order to prevent clinical exacerbation in the long term.