P0242Prognostic factors and long-term outcomes in upper gastrointestinal Crohn’s disease: a scoping review

Abstract Background Upper gastrointestinal (UGI) involvement occurs in a substantial subset of Crohn’s disease (CD) and is variably defined, complicating risk stratification. We mapped prognostic factors and outcomes in adult UGICD. Methods We conducted a scoping review following JBI methodology and PRISMAScR. MEDLINE, Embase, and Cochrane CENTRAL were searched (1995 to November 2024) for studies reporting prognostic factor-outcome associations in adults with UGICD (Montreal L4). Two reviewers screened, extracted and charted data; findings were narratively synthesised. Results Of 3,110 records screened, 317 underwent fulltext assessment, and 42 primary studies were included (31 retrospective, 8 prospective, 3 cross-sectional), encompassing 3800 patients. Median sample size for isolated UGI cohorts was 35 (IQR 23–40). Across 100 unique factor-outcome associations, 88 (88%) addressed long-term outcomes (≥12 months). L4 at diagnosis was independently associated with intestinal stricture (aOR = 2.2; 95% CI 1.1–4.3), disease progression (aOR = 3.4; 95% CI 1.3–9.1), and higher hazard of major abdominal surgery (aHR = 4.0; 95% CI 1.2–13.8). Proximal small-bowel (jejunal/ileal) involvement was linked to increased interventions (RR = 2.5 for strictureplasty; RR = 1.3 for hospitalisation), whereas Esophagogastroduodenal-limited disease followed a more favourable course (aHR = 0.5 for surgery or fistula). Younger age at diagnosis strongly predicted UGI involvement (aOR = 2.6–11.5), while sex effects were inconsistent. Higher baseline endoscopic severity predicted surgery or recurrence in duodenal disease (HR = 2.4). Chronic iron-deficiency anaemia was frequent (OR = 2.2 vs non-L4) but not prognostic for strictures. Conclusion Adult UGICD appears to be a distinct phenotype with a tendency toward stricturing complications and higher surgical needs, particularly when the proximal small bowel is involved; Esophagogastroduodenallimited disease may follow a more favourable trajectory. Standardised UGI definitions, validated biomarkers, and studies evaluating the impact of modern biologic strategies are priority gaps. Conflict of interest: Mr. Elzaanoun, Reyad: No conflict of interest Natt, Navneet: No conflict of interest Lupas, Daniel: No conflict of interest Yuan, Yuhong: No conflict of interest Mortuza, Rokhsana: No conflict of interest Ma, Christopher: Consulting fees: AbbVie, Alimentiv, Amgen, Anaptys Bio, AVIR Pharma Inc, Bristol Myers Squibb, Celltrion, Domain Therapeutics, Eupraxia, Eli Lilly, Ferring, Forte Biosciences, Fresenius Kabi, Gilead, Janssen, McKesson, Merck, Mirador Therapeutics, Pendopharm, Pfizer, Roche, Sanofi, Takeda, Tillotts Pharma Speaker’s fees: AbbVie, Amgen, AVIR Pharma Inc, Alimentiv, Bristol Myers Squibb, Eli Lilly, Ferring, Fresenius Kabi, Janssen, Merck, Organon, Pendopharm, Pfizer, Sanofi, Takeda, Tillotts Pharma Royalties: Springer Publishing Research Support: AbbVie, Eli Lilly, Ferring, Pfizer Danese, Silvio: Personal Fees: AbbVie, Alimentiv, Allergan, Amgen, Applied Molecular Transport, AstraZeneca, Athos Therapeutics, Biogen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Celltrion, Dr Falk Pharma, Eli Lilly, Enthera, Ferring Pharmaceuticals Inc., Gilead, Hospira, Inotrem, Janssen, Johnson & Johnson, Morphic, MSD, Mundipharma, Mylan, Pfizer, Roche, Sandoz, Sublimity Therapeutics, Takeda, Teladoc Health, TiGenix, UCB Inc., Vial, Vifor Lecture fees from Abbvie, Amgen, Ferring Pharmaceuticals Inc., Gilead, Janssen, Mylan, Pfizer, Takeda Peyrin-Biroulet, Laurent: CONSULTING Abbvie, Abivax, Adacyte, Alimentiv, Alfasigma, Amgen, Apini, Banook, BMS, Celltrion, Enthera, Ferring, Fresenius Kabi, Galapagos, Genentech, Gilead, Iterative Health, Janssen, Lilly, LifeMine, Medac, Morphic, MSD, Nordic Pharma, Novartis, Oncodesign Precision Medicine, ONO Pharma, OSE Immunotherapeuthics, Par’ Immune, Pfizer, Prometheus, Roche, Roivant, Samsung, Sandoz, Sanofi, Sorriso, Spyre, Takeda, Teva, ThirtyfiveBio, Tillots, Vectivbio, Vedanta, Ventyx. LECTURE Abbvie, Alfasigma, Amgen, Biogen, Celltrion, Ferring, Galapagos, Genentech, Gilead, Iterative Health, Janssen, Lilly, Medac, MSD, Nordic Pharma, Pfizer, Sandoz, Takeda, Tillots Singh, Siddharth: Research grants from Pfizer Jairath, Vipul: Consulting Fees: Abbvie, Alimentiv, Amgen, Anaptys Bio, Asahi Kasei, Asieris, Astra Zeneca, Attovia, Blackbird Labs, BMS, Boehringer Ingleheim, Biomebank, Caldera, Calluna, Catalytic Health, Celltrion, Ensho, Enthera, Exeliome Biosciences, Ferring, Fresenius Kabi, Gilead, Granite Bio, GSK, Janssen, Lilly, Merck, Mountainfield, MRM Health, Nxera, Organon, OSE Immunotherapeutics, Pendopharm, Pioneering Medicine, Pfizer, Prometheus, Roche/Genentech, Sanofi, SCOPE, Shattuck Labs, Sorriso, Spyre, Synedgen, Takeda, Teva, Tillotts, Union Therapeutics, Ventus, Ventyx, Vividion, Xencor, Zealand Pharma. Sedano, Rocio: has received consulting fees from AbbVie, Alimentiv, Pendopharm and Takeda