342 Journal of Crohn's and Colitis, 2020, 342–350 doi:10.1093/ecco-jcc/jjz155 Advance Access publication November 21, 2019 Original Article Copyright © 2019 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com Original Article Impact of Aphthous Colitis at Diagnosis on Crohn’s Disease Outcomes Charlotte Delattre, a,b Ayanna Lewis, a Julien Kirchgesner, a Isabelle Nion-Larmurier, a Anne Bourrier, a Cécilia Landman, a Guillaume Le Gall, b Harry Sokol, a Laurent Beaugerie, a Philippe Seksik a ; the Saint-Antoine IBD Network a Sorbonne Université, Gastroenterology & Nutrition Department, AP-HP, Hôpital Saint-Antoine, F-75012 Paris, France b Gastroenterology and Hepatology Department, Bégin Military Hospital, Saint Mandé, France Corresponding author: Charlotte Delattre. Email: chadelattre@live.fr . Abstract Background: The natural history of intestinal lesions in Crohn’s disease [CD] is not fully understood. Although the extent of lesions at diagnosis usually defnes the extent of the disease, some lesions seen at diagnosis, particularly aphthous ulcers [AUs], may resolve before follow-up. The aim of this study was to evaluate the outcomes of CD patients with colonic AUs seen at diagnosis. Methods: CD patients with aphthous colitis at diagnosis who had been followed since 2001 were included in a case control study matched with two groups of controls: one without colonic involvement at diagnosis and a second group with colonic lesions more severe than AUs at diagnosis. Results: Seventy-fve patients were included, with a median follow-up of 7.3 years [interquartile range 2.7–9.8]. Seventy-one per cent of those having a second colonoscopy at least 6 months after diagnosis were stable or healed. Medical treatments were similar between the three groups. The AU group’s rate of ileal surgery was similar to those without colitis. In multivariate analysis, the independent factors associated with ileal resection were ileal involvement (odds ratio [OR]: 8.8; 95% confdence interval [CI] [7.68–33.75]; p = 0.002) and the presence of severe colitis (OR = 0.5; 95% CI [0.32–0.79], p = 0.003). The risk of ileal surgery was not infuenced by the presence of aphthous colitis (OR: 0.63; 95% CI [0.37–1.1]; p = 0.1). Conclusion: Aphthous colitis at diagnosis seems to resolve in most patients. This suggests that these lesions are of little clinical signifcance and may not need to be considered prior to ileal resection in CD or when making other important therapeutic decisions. Key Words: Crohn’s disease; apthous ulcers; natural history; colon; ileal surgery 1. Background Aphthous ulceration is a well-known feature of Crohn’s disease [CD]. According to a European consensus, these often subtle lesions, which by defnition are ≤ 5 mm in size, are characterized by a white, depressed centre surrounded by a halo of erythema. 1 Some studies have shown that these ulcerations can be one of the earliest manifest- ations of CD. 2 In CD, anatomical lesions usually progress according to the sequence previously described by Rutgeerts, in which an initial infammatory infltrate of the mucosa leads to superfcial aphthous ulcers [AUs], which then progress to more substantial ulceration. Downloaded from https://academic.oup.com/ecco-jcc/article/14/3/342/5637493 by guest on 30 October 2022