Clinical Features and Long-term Prognosis of Crohn’s Disease in Korea: Results from the Prospective CONNECT Study

Abstract

Background/Aims: The prospective Crohn's Disease Clinical Network and Cohort Study is a nationwide multicenter cohort study of patients with Crohn's disease (CD) in Korea, aiming to prospectively investigate the clinical features and long-term prognosis associated with CD.Methods: Patients diagnosed with CD between January 2009 and September 2019 were prospectively enrolled. They were divided into two cohorts according to the year of diagnosis: cohort 1 (diagnosed between 2009 and 2011) versus cohort 2 (between 2012 and 2019). Results: A total of 1,175 patients were included, and the median follow-up duration was 68 months (interquartile range, 39.0 to 91.0 months). The treatment-free durations for thiopurines (p<0.001) and anti-tumor necrosis factor agents (p=0.018) of cohort 2 were shorter than those of cohort 1. Among 887 patients with B1 behavior at diagnosis, 149 patients (16.8%) progressed to either B2 or B3 behavior during follow-up. Early use of thiopurine was associated with a reduced risk of behavioral progression (adjusted hazard ratio [aHR], 0.69; 95% confidence interval [CI], 0.50 to 0.90), and family history of inflammatory bowel disease was associated with an increased risk of behavioral progression (aHR, 2.29; 95% CI, 1.16 to 4.50). One hundred forty-one patients (12.0%) underwent intestinal resection, and the intestinal resection-free survival time was significantly longer in cohort 2 than in cohort 1 (p=0.003). The early use of thiopurines (aHR, 0.35; 95% CI, 0.23 to 0.51) was independently associated with a reduced risk of intestinal resection. Conclusions:The prognosis of CD in Korea appears to have improved over time, as evidenced by the decreasing intestinal resection rate. Early use of thiopurines was associated with an improved prognosis represented by a reduced risk of intestinal resection.

Comparison of an Endoscopic Scoring System and the Simplified Magnetic Resonance Index of Activity in Patients with Small Bowel Crohn’s Disease

“…40 Considering this clinical progress of patients with small bowel CD, BAE is crucial for evaluating mucosal lesions in these patients. 41 In our cohort, among 77 segments with ileal SES-CD <3 (MH or no definitive ulceration), 13 (17%) segments showed transmural inflammation (MARIAs ≥1). Conversely, in patients with confirmed TH (MARIAs 0), mucosal inflammation (SES-CD ≥3) was observed in eight of 72 segments (11%).…”

Clinical Characteristics of Korean Patients with Elderly-Onset Crohn’s Disease: Results from the Prospective CONNECT Study

“…The prospective CONNECT cohort study reported the clinical features and long-term prognosis of CD of 1,175 patients from January 2009 to September 2019. 16 Among 1,175 CD patients, 94 patients (8.0%) were classified as Montreal classification A3, and we divided these patients into two groups: elderly-onset CD patients (diagnosed with CD after 60 years of age) and late adult-onset CD patients (diagnosed with CD at 41 to 59 years of age). We evaluated and compared the clinical features at diagnosis and clinical course, including medication and bowel resection during the follow-up period, between the two groups.…”