P196 Colon-involving versus non-colon-involving Crohn’s disease classification: is the Montreal classification outdated?

Abstract Background An appropriate disease classification is essential for the management of Crohn’s disease (CD) patients. Recently, a new classification of colon-involving versus non-colon-involving disease extension was considered to be more predictive of adverse outcomes than the Montreal classification (MRC). We aimed to investigate the association of a colon-based classification with clinically relevant outcomes in patients with CD compared with the MRC. Methods Retrospective cohort-study which consecutively included adult CD patients with at least 1 year of follow-up. Patients were categorized into colon-involving and non-colon-involving disease and according to the MRC. Patients’ demographic, clinical, biochemical, and imaging data were recorded and compared between the two classifications. The primary outcome was the need for treatment with steroids or biologics, hospitalization and major abdominal surgery. Results Of 327 patients, 52.3% were female with a mean age of 43.3±13.1 years. The most common disease location according to MRC was L1 (48.9%), followed by L3 (41.3%) and L2 (9.8%). Overall, 51.1% of patients had colon-involving disease. Although patients with colon-involvement at diagnosis had higher frequency of perianal lesions (27.5% vs 16.9%, P<0.05) and serum inflammatory biomarkers (lower hemoglobin, and higher leucocyte and platelet counts, c-reactive protein and erythrocyte sedimentation rate), this classification was not predictive of relevant outcomes. Considering the two types of colon-involving disease (L2, L3), patients with L2 disease had higher extraintestinal manifestations (43.8% vs 20.7%, respectively, P<0.05), higher B1 disease behavior (87.5% vs 58.5%, respectively, P<0.05) and lower B2 disease behavior (6.25% vs 22.2%, respectively, P<0.05). Disease location according to MRC was predictive of the need for treatment with biologics, hospitalization and major abdominal surgery in univariate analysis, but not in multivariate analysis. Conclusion Although simpler, defining Crohn’s disease extension by colon-involving versus non-colon-involving is not more predictive of adverse outcomes than the Montreal classification. Therefore, the use of Montreal Classification should still be considered essential in the adequate management of IBD patients.

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Classifying Crohn’s disease into colon-involving versus non-colon-involving groups is a better predictor of clinical outcomes than the Montreal classification

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284820968732 ◽

2020 ◽

Vol 13 ◽

pp. 175628482096873

Author(s):

Si-Nan Lin ◽

Dan-Ping Zheng ◽

Yun Qiu ◽

Sheng-Hong Zhang ◽

Yao He ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Abdominal Surgery ◽

Clinical Outcomes ◽

Protective Factor ◽

Age Of Onset ◽

Disease Classification ◽

Major Abdominal Surgery ◽

Montreal Classification

Background: A suitable disease classification is essential for individualized therapy in patients with Crohn’s disease (CD). Although a potential mechanistic classification of colon-involving and non-colon-involving disease was suggested by recent genetic and microbiota studies, the clinical implication has seldom been investigated. We aimed to explore the association of this colonic-based classification with clinical outcomes in patients with CD compared with the Montreal classification. Methods: This was a retrospective study of CD patients from a tertiary referral center. Patients were categorized into colon-involving and non-colon-involving disease, and according to the Montreal classification. Clinico-demographic data, medications, and surgeries were compared between the two classifications. The primary outcome was the need for major abdominal surgery. Results: Of 934 patients, those with colonic involvement had an earlier median (interquartile range) age of onset [23.0 (17.0–30.0) versus 26.0 (19.0–35.0) years, p = 0.001], higher frequency of perianal lesions (31.2% versus 14.5%, p < 0.001) and extraintestinal manifestations (21.8% versus 14.5%, p = 0.010), but lower frequency of stricture (B2) (16.3% versus 24.0%, p = 0.005), than those with non-colon-involving disease. Colon-involving disease was a protective factor against major abdominal surgery [hazard ratio, 0.689; 95% confidence interval (CI), 0.481–0.985; p = 0.041]. However, patients with colon-involving CD were more prone to steroids [odds ratio (OR), 1.793; 95% CI, 1.206–2.666; p = 0.004] and azathioprine/6-mercaptopurine (AZA/6-MP) treatment (OR, 1.732; 95% CI, 1.103–2.719; p = 0.017) than were patients with non-colon-involving disease. The Montreal classification was not predictive of surgery or steroids and AZA/6-MP treatment. Conclusion: This study supports the rationale for disease classification based on the involvement of colon. This new classification of CD is a better predictor of clinical outcomes than the Montreal classification.

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Long-term Disease Behavior and Surgical Intervention Analysis in Hospitalized Patients with Crohn's Disease in China: A Retrospective Cohort Study

Inflammatory Bowel Diseases ◽

10.1093/ibd/izab295 ◽

2021 ◽

Author(s):

Xiaoyin Bai ◽

Huimin Zhang ◽

Gechong Ruan ◽

Hong Lv ◽

Yue Li ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Large Scale ◽

Hospitalized Patients ◽

Disease Classification ◽

Real World Data ◽

Disease Behavior ◽

Initial Classification

Abstract Background There is lack of real-world data for disease behavior and surgery of Crohn’s disease (CD) from large-scale Chinese cohorts. Methods Hospitalized patients diagnosed with CD in our center were consecutively included from January 2000 to December 2018. Disease behavior progression was defined as the initial classification of B1 to the progression to B2 or B3. Clinical characteristics including demographics, disease classification and activity, medical therapy, development of cancers, and death were collected. Results Overall, 504 patients were included. Two hundred and thirty one (45.8%) patients were initially classified as B1; 30 (13.0%), 71 (30.7%), and 95 (41.1%) of them had disease progression at the 1-year follow-up, 5-year follow-up, and overall, respectively. Patients without location transition before behavior transition were less likely to experience behavior progression. However, patients without previous exposure to a corticosteroid, immunomodulator, or biological agent had a greater chance of experiencing behavior progression. When the long-term prognosis was evaluated, 211 (41.9%) patients underwent at least one CD-related surgery; 108 (21.4%) and 120 (23.8%) of these patients underwent surgery before and after their diagnosis, respectively. An initial classification as B1, no behavior transition, no surgery prior to diagnosis, and previous corticosteroid exposure during follow-up were associated with a lower risk of undergoing surgery. Conclusions This study depicts the clinical features and factors associated with behavior progression and surgery among hospitalized CD patients in a Chinese center. Behavior progression is associated with a higher probability of CD-related surgery, and strengthened therapies are necessary for them in the early phase.

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Disease Location, Anti-Saccharomyces cerevisiae Antibody, and NOD2/CARD15 Genotype Influence the Progression of Disease Behavior in Crohn’s Disease

Inflammatory Bowel Diseases ◽

10.1097/00054725-200409000-00005 ◽

2004 ◽

Vol 10 (5) ◽

pp. 521-528 ◽

Cited By ~ 69

Author(s):

Ben R. K. Smith ◽

Ian D. R. Arnott ◽

Hazel E. Drummond ◽

Elaine R. Nimmo ◽

Jack Satsangi

Keyword(s):

Saccharomyces Cerevisiae ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Progression Of Disease ◽

Disease Behavior ◽

Disease Location

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Faculty Opinions recommendation of Relationship between proximal Crohn's disease location and disease behavior and surgery: a cross-sectional study of the IBD Genetics Consortium.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717996331.793473999 ◽

2013 ◽

Author(s):

Richard Gearry

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Disease Behavior ◽

Disease Location

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Characteristics of Pediatric Crohn’s Disease in Saudi Children: A Multicenter National Study

Gastroenterology Research and Practice ◽

10.1155/2016/7403129 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 7

Author(s):

Omar I. Saadah ◽

Mohammad El Mouzan ◽

Mohammad Al Mofarreh ◽

Ali Al Mehaidib ◽

Mohammad Al Edreesi ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Positive Family History ◽

Diagnostic Delay ◽

Growth Failure ◽

National Study ◽

Laboratory Findings ◽

First Degree Relatives ◽

Disease Behavior ◽

Disease Location

Background and Aims. Crohn’s disease (CD) is an evolving disease in KSA. Little is known about its characteristics in the Saudi population. The aims of this study were to describe the characteristics of Saudi children with CD and to determine whether the characteristics of CD in KSA are different from those seen in Western countries.Methods. In this study, children younger than eighteen years of age diagnosed with CD between January 2003 and December 2012 were included.Results. Of 330 patients identified, 186 (56.4%) were males. The median age at diagnosis was 15.8 years. A positive family history for IBD in first-degree relatives occurred in 13.6% of patients. The most common symptoms were abdominal pain (84.2%), weight loss (75.2%), and diarrhea (71.8%). The main disease location was ileocolonic (42.1%) and the main disease behavior was nonstricturing and nonpenetrating (63.6%). Perianal involvement was seen in 60 (18.2%) patients. Laboratory findings revealed anemia in 57.9% of patients, low albumin in 34.5%, and high CRP in 39.4%.Conclusions. Saudi children with CD have lower frequency of first-degree relatives with IBD, lower prevalence of early onset disease, longer diagnostic delay, higher prevalence of growth failure, and greater frequency of stricturing and penetrating disease behavior compared to Western patients.

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Different clinical outcomes in Crohn’s disease patients with esophagogastroduodenal, jejunal, and proximal ileal disease involvement: is L4 truly a single phenotype?

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284818777938 ◽

2018 ◽

Vol 11 ◽

pp. 175628481877793 ◽

Cited By ~ 4

Author(s):

Ren Mao ◽

Rui-Han Tang ◽

Yun Qiu ◽

Bai-Li Chen ◽

Jing Guo ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Intestinal Resection ◽

Intestinal Surgery ◽

Montreal Classification ◽

Disease Location ◽

Ileal Disease ◽

Worse Prognosis

Background: The Montreal classification defines L4 Crohn’s disease (CD) as any disease location proximal to the terminal ileum, which anatomically includes L4-esophagogastroduodenal (EGD), L4-jejunal, and L4-proximal ileal involvement. L4-jejunal disease was established to be associated with poor prognosis. However, the outcome of patients with L4-proximal ileal disease or L4-EGD remains to be clarified. Our study aimed to investigate whether the outcome differs among CD patients with L4-EGD, L4-jejunal, and L4-proximal ileal disease. Methods: In our retrospective cohort study, 483 patients with confirmed CD were included. The primary outcome was intestinal surgery. Demographic features and outcomes were compared among L4-EGD, L4-jejunal, and L4-proximal ileal disease. Results: Thirty-nine (8.1%) patients had isolated L4 disease, whereas 146 patients had L4 as well as concomitant L1, L2, or L3 disease. During a median follow up of 5.8 years, L4 patients were more likely to have intestinal surgeries compared to non-L4 patients (31% versus 16%, p < 0.001). The percentage of L4-jejunal patients who underwent surgery was higher than that of L4-proximal ileal (66% versus 28%, p < 0.001), and both of these subtypes of L4 were at higher risk for intestinal resection compared to L4-EGD patients (66% and 28% versus 9%, respectively, p < 0.001 and p < 0.05). On multi-variable analysis, L4-jejunal (HR 3.08; 95% CI 1.30–7.31) and L4-proximal ileal disease (HR 1.83; 95% CI 1.07–3.15) were independent predictors for intestinal resection. Conclusions: L4 disease had worse prognosis compared to non-L4 disease. Within L4 disease, phenotype of L4-jejunal and L4-proximal ileal disease indicated higher risk for intestinal surgery. It might be justified to further characterize the L4 phenotype of the Montreal classification into three specific subgroups including L4-EGD, L4-jejunal, and L4-proximal ileal disease, similar to the Paris classification of pediatric patients.

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Application of the Montreal Classification for Crohn’s Disease to a Single Clinician Database of 1015 Patients

Canadian Journal of Gastroenterology ◽

10.1155/2007/951526 ◽

2007 ◽

Vol 21 (6) ◽

pp. 363-366 ◽

Cited By ~ 30

Author(s):

Hugh J Freeman

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Clinical Features ◽

Complex Disease ◽

Stricture Formation ◽

Age Dependence ◽

Clinical Database ◽

Clinical Expression ◽

Montreal Classification ◽

Disease Location

Crohn’s disease involves different gastrointestinal sites and may be characterized by high rates of strictures and penetrating complications. The present study applied the newly described Montreal schema of classification to a large, prospectively accumulated clinical database. In addition, age dependence was evaluated at diagnosis, with regard to disease location and disease behaviour. There were 1015 consecutively evaluated patients (449 male and 566 female). Disease was most often localized in the ileocolon and was usually complex with stricture formation or penetrating complications. For both sexes, with increasing age at diagnosis, Crohn’s disease was less extensive, more often localized in the colon alone and characterized by less complex disease behaviour, especially with less penetrating disease complications. Using the Montreal classification for Crohn’s disease, these results define the clinical features in a large, single clinician database and demonstrate age dependence in the phenotypic clinical expression of Crohn’s disease.

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Abdominal Surgery in Crohn’s Disease: Risk Factors for Complications

Inflammatory Intestinal Diseases ◽

10.1159/000510999 ◽

2020 ◽

pp. 1-7

Author(s):

Cintia Mayumi Sakurai Kimura ◽

Arceu Scanavini Neto ◽

Natalia Sousa Freitas Queiroz ◽

Natally Horvat ◽

Mariane Gouvea Monteiro Camargo ◽

...

Keyword(s):

Crohn’S Disease ◽

Postoperative Complications ◽

Crohn's Disease ◽

Abdominal Surgery ◽

Disease Risk ◽

Factors Associated ◽

Urgent Surgery ◽

Preoperative Optimization ◽

Increased Risk ◽

Disease Location

Introduction: Abdominal surgery in patients with Crohn’s disease (CD) is challenging, especially in the biologic era. The aim of this study was to evaluate factors associated with increased risk for postoperative complications in CD. Methods: A retrospective study was conducted with consecutive patients who underwent abdominal surgery for CD from January 2012 to January 2018. Results: Of 103 patients, 32% had postoperative complications. Gender, age, disease location and phenotype, hemoglobin and albumin levels, previous abdominal surgery, and preoperative optimization did not differ between the groups with or without complications. Thirty-five percent of the patients were under anti-TNF therapy, and this medication was not associated with increased risk for postoperative complications. Time since the onset of the disease was significantly higher in patients with complications (12.9 vs. 9.4, p = 0.04). In multivariate analysis, creation of ostomy and urgent surgery were the only variables independently associated with increased risk for complications (OR 3.2, 95% CI 1.12–9.46 and OR 2.94, 95% CI 0.98–9.09, respectively). Conclusion: Urgent surgery for CD should preferably be performed in specialized centers, and creation of stoma is not necessarily associated with lower rate of postoperative complications but rather less severe complications.

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5-Aminosalicylic Acid Prevents Disease Behavior Progression and Intestinal Resection in Colonic and Ileocolonic Crohn’s Disease Patients: A Retrospective Study

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2021/1412663 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Jian Wan ◽

Xuan Wang ◽

Yujie Zhang ◽

Xianmin Xue ◽

Yani Li ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Cox Regression ◽

Intestinal Resection ◽

Aminosalicylic Acid ◽

Term Outcome ◽

Long Term Outcome ◽

Disease Behavior ◽

Disease Location

Background and Aims. The efficacy of 5-aminosalicylic acid (5-ASA) in the long-term outcome of Crohn’s disease (CD) patients was uncertain. This study aimed to evaluate the efficacy of the 5-ASA in preventing disease behavior progression and intestinal resection in CD patients. Methods. CD patients were prospectively enrolled from January 2008 to September 2019 in Xijing Hospital. Disease behavior progression was defined as the development of stricturing (B2) or penetrating disease (B3) in patients with nonstricturing/nonpenetrating disease (B1) at diagnosis. Cox regression analyses were used to investigate the associations between disease location progression, disease behavior progression, and intestinal resection and multiple covariates. Results. In total, 122 CD patients were followed up for 4.3 years. At the time of diagnosis, disease location was ileal in 19.7% (24/122), colonic in 41.0% (50/122), and ileocolonic in 39.3% (48/122). A total of 87 (71.3%) patients had B1 at diagnosis. The disease behavior progression and intestinal resection rates were 42.5% (37/87) and 29.5% (36/122). The use of 5-ASA reduced the risk of disease behavior progression (HR 0.30, 95% CI 0.14–0.61, P = 0.001) and intestinal resection (HR 0.33, 95% CI 0.17–0.90, P = 0.027) in colonic and ileocolonic CD patients. Patients who presented with ileal disease at diagnosis did not have the same protective effects when taking 5-ASA ( P > 0.05). Conclusions. The use of 5-ASA could improve the long-term outcome of CD patients with colon involvement. The result emphasized the importance of early use of 5-ASA in the daily management of colonic involved CD.

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