Phenotypic variables associated with progression of disease behaviour In Crohnʼs Disease

Crohn's disease (CD) is characterized by a chronic and relapsing disease course which is variable in severity among patients. Accurate classification during the course of the disease is important in assessing prognosis and ensuring the appropriate treatment is administered for each subgroup. Epidemiological and genetic observations have led to the development of the refined Montreal Classification. Disease behavior, as defined by the Montreal Classification, is one measure of severity and the introduction of a time-dependent classification is an important component of assessing aggressive disease behaviour. Although many patients will have a relatively indolent and benign disease course, the subset of patients with aggressive and rapidly progressive CD are subject to significant morbidity, poor quality of life and substantial economic and health care costs. Predictors of disease progression would be useful to manage patients and identify those that may benefit most from earlier therapeutic intervention. To identify variables associated with rapid progression from B1 (inflammatory) to B2 (fibrostenotic) or B3 (internal penetrating) disease behaviour as defined by the Montreal Classification. A retrospective chart review was conducted on a cohort of 255 CD patients recruited to our IBD genetics studies between 2002-2004 who had at least five years follow-up. Date of diagnosis, age, gender, ethnicity, smoking status, extraintestinal manifestations, disease location and requirement for steroid therapy or surgery were determined. Time to progression from B1 to either B2 or B3 was confirmed using clinical records. Patients were censored at the date of disease behaviour change, or date of most recent assessment, whichever was earliest. Comparisons were made between those who had rapid progression (within 5 years of diagnosis or diagnosed as B2/B3 at baseline), and indolent progression (over 5 years or no change in behaviour). Chi-square statistics were obtained. Of the cohort, 51% were male. The proportions for age categories A1, A2 and A3 were 30%, 64% and 6% respectively. The proportions for ileal (L1), colonic (L2) and ileocolonic (L3) disease were 40%, 25% and 33% respectively. Out of 208 patients who had B1 disease behaviour at diagnosis, 49 (24%) patients progressed to either B2 or B3 within 5 years. Young age group at diagnosis (A1, A2) (p= 0.001), and disease location of either the ileum (L1) or the ileocolon (L3) (p= 0.0003) were statistically significant factors associated with rapid disease progression. Young age at diagnosis and small bowel disease location in CD are associated with progressive CD behaviour to more complex phenotypes. By recognizing disease markers of progressive CD behaviour, clinicians can better identify patients that may most benefit from therapeutic strategies to prevent more debilitating disease.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.