P1304 Mild Crohn’s disease in Sri Lanka: a nationwide study

Abstract Background Crohn’s disease (CD) exhibits geographic variation in prevalence and phenotype, with emerging data suggesting distinct disease patterns in South Asia. This nationwide study aimed to characterise the clinical presentation, disease behaviour, and outcomes of patients with mild CD across Sri Lanka. Methods We conducted a prospective, multicentre study from January - October 2025, enrolling patients with diagnosed or established mild CD (defined as histologically proven CD, age of onset >30 years, no systemic features, limited disease with only aphthoid ulcers on endoscopy) from 18 tertiary care centres across all nine provinces. Data collected included demographics, disease location and behaviour (Montreal classification), laboratory parameters, endoscopic findings and treatment patterns. Disease progression was available for at least 12 months. Results Among 215 patients with CD, mild CD was seen only in 5 patients (7.0%). Mild CD was predominantly among females (67.7%) and with a mean age of onset of 40.53 ( ±  11.20) years. Most mild CD had colonic involvement (86.6%), while some had some ileal involvement (46.6%). The main presentation was weight loss (100%) and altered bowel habits (100.0%), followed by abdominal pain (73.1%). Extraintestinal manifestations (EIMs) were absent among the mild CD [joints (0.0%), eye (0.0%), skin (0.0%)]. The was no history of smoking or history of appendicectomy. A family history of CD was rarely seen in only 13.3%. None were observed without treatment (0.0%), while 13.3% of patients achieved clinical remission with steroid therapy alone, compared to 60.0% requiring earlier immunomodulator escalation. However, 26.7% were treated with biologics. Disease progression to moderate-severe CD occurred in only 26.7% patients who were treated with biologics over the 12-month follow-up period. Conclusion In Sri Lanka, mild CD was rare, seen mostly among females with predominantly colonic involvement. Mild CD demonstrates a favourable disease course with no EIMs, high rates of remission on conventional therapy and low progression to moderate-to-severe disease, suggesting potential genetic, environmental, or dietary protective factors warranting further investigation. Conflict of interest: Niriella, Madunil: No conflict of interest Dr. Jayasena, Hiruni: No conflict of interest Wanniarachchi, Nipuni: No conflict of interest Gunarathna, Vimukthi: No conflict of interest Nirasha, Sanduni: No conflict of interest Dassanayake, Uditha: No conflict of interest Balendran, Karthiha: No conflict of interest Kajendran, Anuratha: No conflict of interest Aryasingha, Sanjeewa: No conflict of interest Peiris, Ranjith: No conflict of interest Fernandopulle, Anthony: No conflict of interest Senanayake, Mananjala: No conflict of interest Kumarasena, Sujeewa: No conflict of interest Upanishad, Isuru: No conflict of interest Liyanaarachchi, Tharanga: No conflict of interest Abeynayake, Dhanushi: No conflict of interest Herath, Piyal: No conflict of interest Kesevan, Thuraisingham: No conflict of interest Keppetiyagama, Chathuranga: No conflict of interest Dinamitra, Nandana: No conflict of interest Wijewantha, Hasitha: No conflict of interest Subasinghe, Chamila: No conflict of interest Rishikesavan, Vithiya: No conflict of interest Thalagala, Eranga: No conflict of interest Perera, Ruwan: No conflict of interest Aponsu, Tilan: No conflict of interest