Incidentally Diagnosed Asymptomatic Crohn's Disease: A Retrospective Cohort Study of Long-Term Clinical Outcomes

Background: Crohn's disease (CD) is occasionally diagnosed in asymptomatic patients who have undergone colonoscopy or imaging for other reasons. The clinical outcome and optimal management of these patients remain poorly defined. Methods: This was a retrospective cohort study of asymptomatic patients with incidental diagnosis of CD from the electronic patient registry of the IBD Unit of Sheba Medical Center in Israel. The primary outcome was defined as the occurrence of a clinical flare. Results: Of the 2700 CD patients in Sheba IBD registry, 60 asymptomatic patients with incidental diagnosis of CD were identified (31/60 males, median age 50.5, 25%-75% interquartile range [IQR] 43.5-57.25 years, median follow-up 4.5 years, 25-75% IQR 2.5-6.75, range 1-15 years). Most of the patients did not receive any treatment after diagnosis (53/60-88.33%). Of these, 5 patients (9.43%) experienced a flare during follow-up (median 4.5 years, IQR 2.5-6.75, range 1-15 years). Patients with subsequent flare had numerically higher CRP at diagnosis than patients who did not flare (2.2, IQR 2.0-3.0 vs 1.04, IQR 1.0-2.2, P = .09). When comparing the group of patients who received treatment immediately after diagnosis (n = 7) with the group who did not receive treatment (n = 53), there was no difference with respect to the survival time without a flare (P = .3). For other secondary outcomes, 3/40 progressed from B1 phenotype to B2, and 3/53 (6%) patients underwent surgery during the follow-up. Conclusions: The majority of patients with an incidental diagnosis of asymptomatic CD can probably be followed-up without immediate treatment. Although most remain asymptomatic and without complications during follow-up, close monitoring for disease progression is prudent.