Clinical Outcome of Crohn's Disease: Analysis According to the Vienna Classification and Clinical Activity

Veloso, Fernando Tavarela; Ferreira, José Tomé; Barros, Luísa; Almeida, Susana

doi:10.1097/00054725-200111000-00005

Cited by 137 publications

(74 citation statements)

References 25 publications

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“…In the historical national cooperative CD study, perianal disease was an independent predictor of unfavourable outcome among 1084 patients [17] . In a Portuguese referral centre cohort testing CD outcome according to Vienna classification and other clinical markers, earlier age at diagnosis, penetrating lesions (including perianal fistulas and abscesses) and ileo-colonic location were associated with unfavourable outcome [18] . In the Olmstedt population-based study, young age was predictive of surgery, irrespective of smoking status [19] .…”

Section: Clinical Predictors Of CD Coursementioning

confidence: 99%

Clinical, serological and genetic predictors of inflammatory bowel disease course

Beaugerie¹

2012

WJG

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Patients with extensive or complicated Crohn's disease (CD) at diagnosis should be treated straightaway with immunosuppressive therapy according to the most recent guidelines. In patients with localized and uncomplicated CD at diagnosis, early use of immunosuppressive therapy is debated for preventing disease progression and limiting the disabling clinical impact. In this context, there is a need for predictors of benign or unfavourable subsequent clinical course, in order to avoid over-treating with risky drugs those patients who would have experienced spontaneous mid-term asymptomatic disease without progression towards irreversible intestinal lesions. At diagnosis, an age below 40 years, the presence of perianal lesions and the need for treating the first flare with steroids have been consistently associated with an unfavourable subsequent 5-year or 10-year clinical course. The positive predictive value of unfavourable course in patients with 2 or 3 predictors ranges between 0.75 and 0.95 in population-based and referral centre cohorts. Consequently, the use of these predictors can be integrated into the elements that influence individual decisions. In the CD postoperative context, keeping smoking and history of prior resection are the strongest predictors of disease symptomatic recurrence. However, these clinical predictors alone are not as reliable as severity of early postoperative endoscopic recurrence in clinical practice. In ulcerative colitis (UC), extensive colitis at diagnosis is associated with unfavourable clinical course in the first 5 to 10 years of the disease, and also with long-term colectomy and colorectal inflammation-associated colorectal cancer. In patients with extensive UC at diagnosis, a rapid step-up strategy aiming to achieve sustained deep remission should therefore be considered. At the moment, no reliable serological or genetic predictor of inflammatory bowel disease clinical course has been identified.

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Section: Clinical Predictors Of CD Coursementioning

confidence: 99%

Clinical, serological and genetic predictors of inflammatory bowel disease course

Beaugerie¹

2012

WJG

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“…Santos Dumont, km 5 -Condomínio Parque Encontro das Águas, Lote G31 -42700-000 -Lauro de Freitas, BA, Brazil. E-mail: genoile@uol.com.br et al (14) detected differences in prognosis between subgroups of patients with Crohn's disease classified according to criteria of Vienna. LOUIS et al (9) found changes in the clinical behavior during the course of the disease.…”

Section: Introductionmentioning

confidence: 99%

Application of the Vienna classification for Crohn’s disease to a single center from Brazil

Santana

Souza

Azevedo

et al. 2008

Arq. Gastroenterol.

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BACKGROUND: Crohn’s disease is a chronic inflammatory disorder with diversity on its clinical presentation that may be observed from the varying age of onset of symptoms to the site of occurrence of the illness. There is a need for a replicable and uniform description of the disease allowing a comparison between distinct study populations. The 1998 Vienna classification characterizes patients according to three clinical aspects: age at diagnosis, location and disease behavior. AIM: To describe Crohn’s disease in patients from a reference center of Salvador, BA, Brazil according to the Vienna classification. METHODS: Between January and October of 2005, patients (n = 47) having at least one endoscopic and radiological examination of the intestine participated in this study. RESULTS: Most of the participants had the diagnosis of the disease when they were younger than 40 years old (70.2%) while an ileocolic location (38.3%) and the penetrating form (46.8%) were the most prevalent clinical presentation. The restricted location of the ileum (L1) was more frequent in nonstricturing, nonpenetrating disease (B1) while the ileocolic disease (L3) was more associated with the penetrating behavior (B3). CONCLUSION: In this study, differently from the first description of the Vienna classification, the large number of patients presenting a complicated stage of the disease can be attributed to the fact that it was carried out at a reference center, where many patients present with the disease at an advanced stage.

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“…Patients with perianal disease were more likely to have colonic disease (30) whereas patients with internal fistulizing disease were more likely to have ileal or ileocolonic disease and are more likely to require intestinal resection (31).…”

Section: Introductionmentioning

confidence: 99%

Clinical presentation of Crohn's disease: association between familial disease, smoking, disease phenotype, extraintestinal manifestations and need for surgery

Lakatos¹,

Szalay²,

Tulassay³

et al. 2005

Z Gastroenterol

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Background/Aims: Recent molecular data suggest that genetic factors may underlie the disease heterogeneity observed in Crohn's disease (CD). It was also suggested that familial inflammatory bowel disease (IBD) is a homogenous subgroup, phenotypically different from sporadic disease. Our aim was to determine the clinical presentation in a large CD population. Methodology: 564 CD patients (m/f: 278/286, age: 37.4 (SD 12.7) yrs, duration: 8.4 (7.1) yrs) were included. Disease phenotype was determined according to Vienna classification. Familial disease, extraintestinal manifestations (EIM), need for surgery and smoking habits were also analyzed. Results: Familial IBD was present in 73 (12.9%) patients. Age at onset and presence of EIMs was associated with familial disease. Penetrating (44.6% vs. <10yrs: 29.1%, P<0.0001) and ileocolonic disease (54.4% vs. 42.8%, P=0.03) were more common in patients with a disease duration of ≥10yrs. In a logistic regression model female gender, colonic/ileocolonic location, smoking and familial IBD were independent risk factors for EIMs, while ileal and non-inflammatory disease increased the risk for resections. Smoking was also associated with frequent relapses. Conclusions: Familial IBD was associated with the presence of EIMs, while ileal involvement and noninflammatory behavior independently increased the risk for surgery. Since penetrating and extensive disease was more frequent in patients with longer disease duration our data support a possible change in location and behavior during the course of disease.

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Clinical Outcome of Crohn's Disease: Analysis According to the Vienna Classification and Clinical Activity

Cited by 137 publications

References 25 publications

Clinical, serological and genetic predictors of inflammatory bowel disease course

Clinical, serological and genetic predictors of inflammatory bowel disease course

Application of the Vienna classification for Crohn’s disease to a single center from Brazil

Clinical presentation of Crohn's disease: association between familial disease, smoking, disease phenotype, extraintestinal manifestations and need for surgery

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