Abstract
Crohn’s disease (CD) is occasionally diagnosed in asymptomatic patients undergoing colonoscopy for other reasons, but their clinical outcomes and optimal management remain poorly defined.
A retrospective cohort study of asymptomatic patients with incidental diagnosis of CD. The primary outcome was defined as the occurrence of a clinical flare. Secondary outcomes included time to clinical flare, time to initiation of corticosteroids or immunomodulators/biologics, and rate of surgery.
Of the 2558 patients in Sheba IBD registry, 53 asymptomatic patients with incidental diagnosis of CD were identified (median age 50 (41.75-57), 52% males, 32/53 with L1, 9/53 L2, 11/53 L3,1/53 L4, 41/53 B1, 10/53 B2, 2/53 B3, 1 with perianal disease). Most patients (48/53) did not receive any treatment after diagnosis. Of these untreated patients, 43/48 (89.5%) had not experienced a flare over a median follow-up of 4.5 years (IQR 2-8, range 1-15 years). None of the patients with over 8 years follow-up (n=14) experienced a flare. When comparing the group of patients with or without immediate post-diagnosis initiation of treatment (n=5, n=48, respectively), there was no difference in survival time without flare (p=0.3). Of the 48 patients without immediate treatment, immunomodulators/biologics were initiated in 4(8.3%) during follow-up. Surgery for CD occurred in 2 patients during the follow-up. None of the parameters examined, including age, CRP, ileal versus other locations, or having a complicated phenotype (B2/B3 versus B1) was found to predict a clinical flare later on.
Many asymptomatic patients with an incidental diagnosis of Crohn’s disease can probably be followed-up without immediate treatment. Although the majority remain asymptomatic and without complications during follow-up, close monitoring for disease progression is prudent.
