Application of the Vienna Classificaton for Crohn's Disease to a Single Clinician Database of 877 Patients

An international working party at the World Congress of Gastroenterology held in Vienna, Austria from September 6 to 11, 1998 defined a classification for Crohn's disease based on patient age at diagnosis (eg, less than 40 years of age, 40 years of age or older), disease location (eg, terminal ileum, colon, ileocolon or upper gastrointestinal tract) and behaviour (eg, stricturing, penetrating). Disease location in the upper gastrointestinal tract was defined by disease being present proximal to the terminal ileum, regardless of terminal ileal or colon involvement. A 20-year, single clinician database of 877 patients from a university campus hospital was used, and comprised 492 women (56.1%) and 385 men (43.9%). Of these patients, 740 (84.4%) were diagnosed before age 40 years and 137 (15.6%) were diagnosed by 40 years of age or older. Disease was located in the terminal ileum alone in 222 patients (25.3%), colon alone in 238 patients (27.2%) and ileocolon in 304 patients (34.6%). Another 113 patients (13.1%) had disease in the upper gastrointestinal tract, usually with disease also in the terminal ileum (23 patients), colon (12 patients) or ileocolon (71 patients). Only seven of 877 patients had disease located in the upper gastrointestinal tract alone with no distal disease. Disease behaviour could be classified as nonstricturing and nonpenetrating in 256 patients (29.2%), stricturing in 294 patients (33.6%) and penetrating in 327 patients (37.2%). Of the 877 patients with Crohn's disease, 837 were white, 38 were Asian and two were black. In this tertiary care setting of a single clinician practice in a Canadian teaching hospital at the University of British Columbia, Crohn's disease predominantly affects women, and young adults with a high rate of stricturing and penetrating complications.

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Frequency and characteristics of granulomas in 368 pediatric patients with Crohn’s disease

Orvosi Hetilap ◽

10.1556/oh.2013.29725 ◽

2013 ◽

Vol 154 (43) ◽

pp. 1702-1708 ◽

Cited By ~ 3

Author(s):

Katalin Eszter Müller ◽

Péter László Lakatos ◽

Mária Papp ◽

Gábor Veres

Keyword(s):

Crohn’S Disease ◽

Gastrointestinal Tract ◽

Crohn's Disease ◽

Terminal Ileum ◽

Clinical Characteristics ◽

Upper Gastrointestinal Tract ◽

Multiple Biopsies ◽

Bowel Diseases ◽

Inflammatory Bowel ◽

Upper Gastrointestinal

Introduction: Epitheloid granulomas are one of the best histological criteria for distinguishing Crohn’s disease from other inflammatory bowel diseases. However, the role of granuloma in the pathogenesis and clinical characteristics of Crohn’s disease is unclear. Aim: The aim of the present study was to evaluate the frequency of granulomas and their association with clinical characteristics using the database of the Hungarian Pediatric Inflammatory Bowel Disease Registry. Method: Three hundred and sixty-eight children with Crohn’s disease were registered between January 1st, 2007 and December 31st, 2010. Results: The frequency of granulomas was 31.4% (111/353) at diagnosis. Isolated granuloma in the upper gastrointestinal tract was detected in 2.5% of patients, while those in the terminal ileum was found in 5% of patients. There was no difference in location, behavior and disease activity indexes between patients with and without granulomas. Need for immunomodulators and biological therapy was similar in the two groups in the first year of diagnosis. Conclusions: The frequency of granulomas in this cohort was comparable to the frequency reported in other studies. Interestingly, granulomas in the terminal ileum or upper gastrointestinal tract contributed to the diagnosis of Crohn’s disease in one of 13 children. These data indicate that multiple biopsies from multiple sites are essential for the diagnosis of pediatric Crohn’s disease. Orv. Hetil., 154 (43), 1702–1708.

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Systematic review with meta-analysis: The prevalence, risk factors and outcomes of upper gastrointestinal tract crohn's disease

Digestive and Liver Disease ◽

10.1016/j.dld.2021.07.037 ◽

2021 ◽

Author(s):

Yip Han Chin ◽

Cheng Han Ng ◽

Snow Yunni Lin ◽

Sneha Rajiv Jain ◽

Gwyneth Kong ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Crohn’S Disease ◽

Gastrointestinal Tract ◽

Crohn's Disease ◽

Meta Analysis ◽

Upper Gastrointestinal Tract ◽

Upper Gastrointestinal

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Upper Gastrointestinal Crohn’s Disease: Literature Review and Case Presentation

Case Reports in Gastrointestinal Medicine ◽

10.1155/2019/2708909 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Soorya N. Aggarwal ◽

Yana Cavanagh ◽

Lan Wang ◽

Amer Akmal ◽

Matthew A. Grossman

Keyword(s):

Crohn’S Disease ◽

Gastrointestinal Tract ◽

Iron Deficiency ◽

Crohn's Disease ◽

Fecal Calprotectin ◽

Upper Gastrointestinal Tract ◽

Laboratory Evaluation ◽

Deficiency Anemia ◽

Endoscopic Evaluation ◽

Upper Gastrointestinal

Upper gastrointestinal tract predominant Crohn’s Disease (CD) remains an elusive clinical entity, manifesting limited or vague symptomatology, eluding clinical suspicion, and delaying subsequent diagnostic evaluation. As a result, it has not been widely described and there is a lack of clear recommendations for diagnosis or management. Standard IBD evaluation including serologic testing, imaging, and endoscopy may initially not be fruitful. Furthermore, endoscopic evaluation may be grossly normal in patients without long standing-disease. We describe an 18-year-old male who presented with only unexplained, persistent iron-deficiency anemia. Extensive outpatient testing including multiple endoscopic evaluations with standard biopsies was unfruitful. Ultimately, a positive fecal calprotectin prompted enteroscopy with endoscopic mucosal resection (EMR) in an effort to obtain a larger, deeper tissue specimen. Grossly cobblestoned mucosa along with histopathology revealing focal crypt abscesses, chronic inflammation in the lamina propria, and superficial foveolar epithelial regenerative changes were consistent with CD. This patient’s case illustrates the need for a high degree of suspicion for CD in patients with unexplained or persistent iron deficiency anemias. Persistent investigation yielded an elevation in fecal calprotectin suggesting underlying gastrointestinal inflammation and prompted advanced endoscopic evaluation with EMR. Waxing and waning tissue findings are characteristic of CD and pose a unique challenge in patients with upper gastrointestinal predominant pathology. As such, diligent workup including laboratory evaluation, imaging, and serial endoscopy is critical to establish pathology and dictate subsequent management in IBD, especially upper gastrointestinal tract predominant CD.

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