Abstract
Background
Environmental and genetic factors might affect Crohn’s disease (CD) course. These are significantly different in developing countries such as India compared with the West, and may affect triggers of disease development and its early course. We aimed to assess early CD course in patients in India compared with Israeli patients (‘TiiiGER’ project).
Methods
Adults (>18 years) diagnosed with CD using accepted clinical, endoscopic and histologic criteria were prospectively recruited. Disease acceleration was defined by the first CD-related surgery, CD-related hospitalisation or recommendation to start steroids, immunomodulatory or biologic therapy.
Results: Overall 104- Indian and 156-Israeli patients were recruited. Indian patients had male predominance (65.4% vs. 50.6%, p = 0.019), were diagnosed at a significantly older age (37.8 ± 12.8 vs. 31.8 ± 12.8 years, p < 0.0001), had significantly more colonic disease location (35.6% vs. 19.2%, p = 0.003), and more stenotic behaviour (36.6% vs. 6.5%, p < 0.0001), compared with Israelis. During a mean follow-up of 14.5 ± 2.7 months, disease acceleration occurred in 50% of Indian and 66.7% of Israeli patients, within a median of 7.6 (interquartile range [IQR] 1.9–25.6) and 3.4 (IQR 1.3–23) months, p = 0.05. A lower ratio of Indian patients was treated with steroids, immunomodulatory or biologic therapy (hazard ratio 0.563; 95% CI, 0.373–0.851, p = 0.006).
Conclusion
In this Indo-Israeli inception cohort, more than half of the patients with newly diagnosed CD experienced early disease acceleration. Distinct features, different rates of disease acceleration and treatment policies, highlight the global need for research into key factors in IBD evolution across ethnically and geographically diverse populations.
*The final two authors contributed equally.
P403 Treatment naïve newly diagnosed patients with Crohn's disease have microbial dysbiosis correlated with disease activity and faecal calprotectin—results from a prospective inception cohort