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Introduction Crohn’s disease (CD) progression can result in bowel damage (BD) and disability. Little is known about BD in early CD. The Crohn’s Disease Cohort (CROCO) is a multicentre prospective European study enrolling newly diagnosed CD patients (<1 year since diagnosis) to characterise BD and disability trajectories.Methods CROCO enrolled 539 newly diagnosed CD patients across 19 centres (median interval between diagnosis and inclusion: 3.7 months [IQR 1.5–7.3]). BD is assessed using the Lémann Index (LI) at years 1, 3, and 5 post-diagnosis (LI=0 defined as no BD; LI>0 as any BD). Using magnetic resonance imaging and endoscopy, BD is assessed using the Lémann Index (LI) at years 1(Y1), 3, and 5 after diagnosis. Absence of BD was defined as LI=0, and any BD as LI>0. We report BD at Y1 and the IBD-Disability index (IBD-DI).Results 539 patients were enrolled, the median interval between diagnosis and inclusion was 3.7 months (IQR 1.5–7.3). Complete Lémann Index (LI) data was captured in 415 patients [57% male; median age 35 years (IQR 25–50)]. At inclusion, 89% had ileal or ileocolonic disease, 73% an inflammatory phenotype, and 8% perianal involvement.Within six months of diagnosis, 18% received 5ASA, 30% systemic corticosteroids, 36% immunosuppressants, and 61% advanced therapy (AT) (91% antiTNF). Median time to AT initiation was 3.5 months (IQR 1.4–5.7), with 48% commencing treatment within six months. Overall, 64% demonstrated some degree of bowel damage (LI > 0), although the median LI remained low [0.6 (IQR 0–1)].Univariate analysis identified colonic disease (L2) as protective against bowel damage (p = 0.012). B2/B3 behaviour (p < 0.001) and perianal disease (p = 0.005) were associated with bowel damage at Y1. In multivariate analysis, only B2/B3 behaviour (p < 0.001) and perianal disease (p = 0.008) remained independently associated.No association was observed between bowel damage and moderatetosevere disability (OR 1.06, 95% CI 0.52–2.15, p = 0.88).Conclusions In this cohort of newly diagnosed CD patients, two-thirds demonstrated BD evidence at one year. Isolated colonic disease was protective against development of BD. No association was found between BD and disability.Abstract P203 Table 1Association between the Lémann index at Y1Multivariate logistic regression modelVariablesOR (95% CI)p-valueDisease location L1/L3: ileal/ileocolonic L2: colonic0.49 (0.17 to 1.28)0.15Disease behaviour B1 B2/B31.0014.08 (5.57 to 45.2)<0.0001Perianal disease5.5 (1.51 to 29.63)0.008Treatment category in the first 6 months No medical treatment 5ASA monotherapy Steroids (excluding topical steroids) ISS monotherapy Advanced therapy Enteral nutrition or Crohn’s disease exclusive diet monotherapy1.000.35 (0.07 to 1.76)0.3 (0.09 to 0.88)0.22 (0.05 to 0.82)0.33 (0.1 to 0.93)2.58 (0.2 to 367.69)0.11