Please use this identifier to cite or link to this item: http://hdl.handle.net/1822/59777

TitleClinical course in Crohn's disease: factors associated with behaviour change and surgery
Author(s)Arieira, Cátia
Gonçalves, Tiago Cúrdia
Castro, Francisca Dias de
Moreira, Maria João
Cotter, José Almeida Berkeley
KeywordsCrohn’s Disease
Montreal classification
phenotype progression
surgery
Issue date2018
PublisherTaylor and Francis
JournalScandinavian Journal of Gastroenterology
Abstract(s)Crohn's disease (CD) is a chronic and progressive disease that changes its behaviour over time. Transmural inflammation in CD leads to stricturing and/or penetrating complications.
Background: Crohn’s disease (CD) is a chronic and progressive disease that changes its behaviour over time. Transmural inflammation in CD leads to stricturing and/or penetrating complications. Aim: To evaluate the frequency of long-term progression of CD phenotypes, the need of abdominal surgery, and the main factors associated with these outcomes. Methods: A retrospective study was conducted with a prospective follow-up. Montreal classification was assessed at the moment of the diagnosis and at the end of the follow-up period. Results: Two hundred and ninety patients were included, with mean follow-up duration of nine years. A change in behaviour was observed in 46 patients (15.9%). Ileocolic location (60.9% vs. 45.1%; p ¼ .049), age at diagnosis <16 years (8.7% vs. 2.0%; p ¼ .017), the use of steroids at diagnosis (43.2% vs. 27.0%; p ¼ .031) and shorter exposure time to biological therapy (15.9 months vs 41.3 months; p < .001) were identified as risk factors for phenotype change. Regarding surgery, 70 patients (24.1%) were submitted to abdominal surgery. Smoking habits (41.3% vs. 26.9%; p ¼ .048), stricturing behaviour (50% vs. 18.4%; p < .001), penetrating behaviour 34.8% vs. 7.8%; p < .001), hospitalisations in the first year of diagnosis (52.3% vs. 12.4%; p < .001), and use of steroids at diagnosis (61.4% vs. 23.6%; p < .001) were more frequently seen in patients subjected to surgery. Patients subjected to surgery were less frequently treated with biological therapy (8.7% vs. 23.4%; p < .025). Conclusions: A behaviour progression was observed in about one-sixth of the patients. Progression to a stricturing pattern was the most frequent change in behaviour. Stricturing and penetrating behaviour, higher number of hospitalisations in the first year of diagnosis, use of steroids at diagnosis, smoking status, age at diagnosis <16 years and ileocolic disease location were associated with an unfavourable clinical evolution.
TypeArticle
URIhttp://hdl.handle.net/1822/59777
DOI10.1080/00365521.2018.1503709
ISSN0036-5521
Peer-Reviewedyes
AccessRestricted access (Author)
Appears in Collections:ICVS - Artigos em Revistas Internacionais com Referee

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