Crohn's disease in a southern European country: Montreal classification and clinical activity

• Published in: Inflammatory bowel diseases 2009-09, Vol.15 (9), p.1343-1350
• Main Authors: Magro, Fernando, Portela, Francisco, Lago, Paula, de Deus, João Ramos, Vieira, Ana, Peixe, Paula, Cremers, Isabelle, Cotter, José, Cravo, Marília, Tavares, Lourdes, Reis, Jorge, Gonçalves, Raquel, Lopes, Horácio, Caldeira, Paulo, Ministro, Paula, Carvalho, Laura, Azevedo, Luis, Da Costa‐Pereira, Altamiro
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age of Onset; clinical activity; Cohort Studies; Crohn Disease - classification; Crohn Disease - drug therapy; Crohn Disease - epidemiology; Crohn's disease; Cross-Sectional Studies; Europe; Female; Humans; Immunosuppressive Agents - therapeutic use; Male; Middle Aged; Montreal Classification; Portugal; Portugal - epidemiology; predictive factors; Registries; Risk Factors; southern Europe; Treatment Outcome; Young Adult
• ISSN: 1078-0998; 1536-4844
• DOI: 10.1002/ibd.20901

Background: Given the heterogeneous nature of Crohn's disease (CD), our aim was to apply the Montreal Classification to a large cohort of Portuguese patients with CD in order to identify potential predictive regarding the need for medical and/or surgical treatment. Methods: A cross‐sectional study was used based on data from an on‐line registry of patients with CD. Results: Of the 1692 patients with 5 or more years of disease, 747 (44%) were male and 945 (56%) female. On multivariate analysis the A2 group was an independent risk factor of the need for steroids (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.1–2.3) and the A1 and A2 groups for immunosuppressants (OR 2.2; CI 1.2–3.8; OR 1.4; CI 1.0–2.0, respectively). An L3+L34 and L4 location were risk factors for immunosuppression (OR 1.9; CI 1.5–2.4), whereas an L1 location was significantly associated with the need for abdominal surgery (P < 0.001). After 20 years of disease, less than 10% of patients persisted without steroids, immunosuppression, or surgery. The Montreal Classification allowed us to identify different groups of disease severity: A1 were more immunosuppressed without surgery, most of A2 patients were submitted to surgery, and 52% of L1+L14 patients were operated without immunosuppressants. Conclusions: Stratifying patients according to the Montreal Classification may prove useful in identifying different phenotypes with different therapies and severity. Most of our patients have severe disease. (Inflamm Bowel Dis 2009)