P0291Clinical course and therapeutic needs in colonic Crohn’s disease: A retrospective comparison with ileal Crohn’s disease and ulcerative colitis.

Background Colonic Crohn’s disease (CCD) is a distinct phenotype that may follow a different clinical course. We aimed to compare therapeutic needs, surgery, complications, and hospitalizations in patients with CCD, ileal Crohn’s disease (ICD), and ulcerative colitis (UC). Methods We conducted a single-center retrospective study including patients diagnosed with CCD, ICD, and UC (extensive or left-sided) between January 2005 and December 2023. Patients with ileocolonic Crohn’s disease (L3) or ulcerative proctitis (E1) were excluded. Descriptive and survival analyses were performed to assess the use of immunosuppressants (thiopurines, methotrexate, cyclosporine, tofacitinib, upadacitinib, and filgotinib), biologics (anti-TNF agents, vedolizumab, ustekinumab), surgery (abdominal and perianal), hospitalizations, and complications (progression to stricturing/penetrating phenotype and/or need for surgery). Outcomes were compared across the three cohorts, and prognostic factors were evaluated using Cox regression analysis. Results A total of 965 patients were included (102 CCD, 357 ICD, and 506 UC). Baseline characteristics are shown in Table 1. CCD was predominantly inflammatory, with higher rates of perianal disease and extraintestinal manifestations compared with ICD. Mean follow-up was 156±62 months. Use of immunosuppressants, biologics, and surgery was higher in the CD groups compared with UC (immunonosuppressants: 62% CCD, 53% ICD, 38% UC, biologics: 43% CCD, 48% ICD, 27% UC, surgery: 21% CCD, 31% ICD, 7.3% UC); however, no differences were observed between CCD and ICD (Figure 1). Hospitalization rates were similar across cohorts. Complications were more frequent in ICD than in CCD (42% vs 24%, p = 0.014). Multivariate analysis showed that perianal disease and ICD were associated with increased use of immunosuppressants, biologics, and surgery. Stricturing and penetrating behavior also increased the risk of surgery. CCD was not associated with worse prognosis in multivariate analysis (Table 2). Conclusion CCD is predominantly inflammatory at diagnosis and throughout its course; however, it exhibits medical and surgical requirements comparable to those of ICD and differs from UC. This may be largely attributable to the high prevalence of associated perianal disease References: 1. Atreya R. Location is important: differentiation between ileal and colonic Crohn’s disease. Nat Rev Gastroenterol Hepatol. 2021 Aug;18(8):544-558. 2. Arora U. Colonic Crohn’s Disease Is Associated with Less Aggressive Disease Course Than Ileal or Ileocolonic Disease. Dig Dis Sci. 2018 Jun;63(6):1592-1599. 3. Giordano A. Ileal Predominance in Crohn’s Disease Is Associated With Increased Intestinal Surgery and Biological Therapy Use, With Lower Treatment Persistence. Am J Gastroenterol. 2025 Jan 1;120(1):194-203. Conflict of interest: Dr. Mesonero Gismero, Francisco: I ve served as a speaker for and received consulting fees from MSD, AbbVie, Takeda, Janssen, Pfizer, Ferring Pharmaceuticals, Kern Pharma, Dr. Falk Pharma, Galapagos, Lilly, Chiesi Farmaceutici, and Faes Farma. Garcia De La Filia Molina, Irene: I ve served as a speaker for and received consulting fees from MSD, AbbVie, Takeda, Janssen, Pfizer, Ferring Pharmaceuticals, Kern Pharma, Dr. Falk Pharma, Galapagos, Lilly, Chiesi Farmaceutici, and Faes Farma. López Cardona, Julia: No conflicts of interest. Fernández Fernández, Cristina: No conflict of interest Lobo Bartol, Virginia: No conflict of interest Die Trill, Javier: No conflict of interest Agustín, Albillos: No conflict of interest