P0847Crohn’s Disease Patients with a Penetrating Phenotype Benefit Most from Surgical Therapy

Background Current guidelines insufficiently define surgical indications for Crohn’s disease. The term therapeutic refractoriness is frequently used as a key criterion but remains poorly defined, leading to non-standardized decision-making and uncertainty among both patients and physicians. A phenotype-based approach may facilitate clearer surgical decision processes. The aim of this study was to compare the benefit of surgical therapy between penetrating and non-penetrating disease phenotypes. Methods All patients who underwent intestinal resection for Crohn’s disease at a tertiary referral center between June 2022 and April 2025 were invited to complete the IBD-Q(Inflammatory bowel disease questionaire) and IBD-DI (Inflammatory bowel disease disability index) questionnaires one day before surgery and six months postoperatively. The IBD-Q comprises 32 items, the IBD-DI 14 items. The primary endpoint was the change in quality of life between the pre and postoperative assessments. A penetrating phenotype was defined by the presence of intraabdominal fistulas, abscesses, or an inflammatory mass. Results A total of 97 patients were included: ileocolic resection in 77, other colorectal resections in 13, and smallbowel resection in 7 cases. Forty patients had a penetrating and 57 a nonpenetrating phenotype. Postoperative morbidity was 25%, with intraabdominal septic complications occurring in five patients (5%). Preoperatively, IBD-Q (127 vs. 138) and IBD-DI scores (44 vs. 42) did not differ significantly between groups. Six months after surgery, absolute scores were comparable (IBD-Q: 179 vs. 169; IBD-DI: 23 vs. 31). However, patients with a penetrating phenotype showed significantly greater improvements between pre- and postoperative values (IBD-Q: +52 vs. +29, p = 0.006; IBD-DI: −21 vs. −13, p = 0.031). Conclusion Surgical therapy improves quality of life in Crohn’s disease regardless of disease phenotype. However, patients with a penetrating course experience a markedly greater benefit. Conflict of interest: Ms. Schmitz, Aline: No conflict of interest Bercher, Magdalena: No conflict of interest Mitas, Costas: No conflict of interest Iesalnieks, Igors: Personal Fees: In the past, I received speaker’s fees from AbbVie, Takeda, Ethicon and Jansson, Lilly, Galapagos