AbstractBackgroundCrohn’s disease (CD) is a chronic autoimmune disease in which inflammation can progress to complications of stricturing and/or penetrating disease. Real-world data on burden of complicated CD phenotypes are limited.MethodsWe analyzed cross-sectional data from the SPARC IBD (Study of a Prospective Adult Research Cohort with Inflammatory Bowel Disease) registry from 2016 to 2020. Four mutually exclusive phenotype cohorts were created: inflammatory CD (CD-I), complicated CD (stricturing CD, penetrating CD, and stricturing and penetrating CD [CD-SP]). Statistical analyses were performed using CD-I as the reference.ResultsA total of 1557 patients were identified: CD-I (n = 674, 43.3%), stricturing CD (n = 457, 29.4%), penetrating CD (n = 166, 10.7%), and CD-SP (n = 260, 16.7%). Patients with complicated phenotypes reported significantly greater use of tumor necrosis factor inhibitors (84.2%-86.7% vs 66.0%;P< .001) and corticosteroids (75.3%-82.7% vs 68.0%;P< .001). Patients with CD-SP reported significantly more aphthous ulcer (15.4% vs 10.5%;P< .05), erythema nodosum (6.5% vs 3.6%;P< .05), inflammatory bowel disease-related arthropathy (25.8% vs 17.2%;P< .01), liquid stools (24.2% vs 9.3%;P< .001), nocturnal fecal incontinence (10.8% vs 2.5%;P< .001), and CD-related surgery (77.7% vs 12.2%;P< .001).ConclusionsPatients with complicated CD phenotypes reported higher rates of active CD-related luminal and extraintestinal manifestations, and underwent more surgeries, despite being more likely to have received biologics than those with CD-I. The potential for early recognition and management of CD-I to prevent progression to complicated phenotypes should be explored in longitudinal studies.