Perianal disease, small bowel disease, smoking, prior steroid or early azathioprine/biological therapy are predictors of disease behavior change in patients with Crohn’s disease

Lakatos, Péter L.; Czegledi, Zsofia; Szamosi, Tamás; Banai, János; Dávid, Gyula; Zsigmond, F; Pandúr, Tünde; Erdélyi, Zsuzsanna; Gemela, Orsolya; Papp, J.; Lakatos, László

doi:10.3748/wjg.15.3504

Cited by 100 publications

(82 citation statements)

References 30 publications

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“…The authors found that over 10 years, 45.9% of patients had a change in disease behavior; the most significant changes were from B1 to B2 or B3 behavior (15) . Another recent study considering 340 well-characterized CD patients showed that perianal disease, disease location, and smoking are some independent predictors of disease behavior change (13) . In the present study the changing of disease behavior over time was not assessed; on the other hand, patients were grouped according to disease duration; the results showed that patients with higher disease duration (>10 years) had lesser rates of B1 behavior and higher rates of B2 and B3 behavior, when compared to those with lesser disease duration (<10 years).…”

Section: Discussionmentioning

confidence: 99%

The Montreal classification for Crohn's disease: clinical application to a Brazilian single-center cohort of 90 consecutive patients

Torres

Rodrigues

Junqueira

et al. 2010

Arq. Gastroenterol.

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CONTEXT: Crohn's disease presents very heterogeneous features from a clinical point of view, and classifying Crohn's disease patients in homogeneous subgroups in the light of genetic, molecular and clinical aspects is challenging. The Montreal Classification for Crohn's disease was proposed in 2005 as an effort to characterize Crohn's disease patients according to recent clinical and research advances in the field of inflammatory bowel disease. Since its proposition, the Montreal Classification needs an ample validation and application among different populations around the world. To date, there are no known studies applying the Montreal Classification to a Brazilian cohort of Crohn's disease patients. OBJECTIVES: To apply the Montreal Classification to a Brazilian cohort of Crohn's disease patients at a referral center for inflammatory bowel disease in Northwestern São Paulo State, Brazil. METHODS: We selected 90 consecutive well-characterized Crohn's disease patients assisted at Inflammatory Bowel Disease Outpatient Clinic between January 1992 and January 2007, with a minimum follow-up of 2 years; data concerning demographic characteristics, clinical onset of disease, age at diagnosis, time of disease, location and behavior of disease, presence of extraintestinal manifestations, familial occurrence, perianal involvement, treatment with biological drugs, and history of surgical treatment were evaluated. RESULTS: Male patients were predominant (54%), with a mean age at diagnosis of 33 ± 14 years old, and a median followup of 5.5 years. Most of the patients were diagnosed between 17 and 40 years old (59%), and had disease located in terminal ileum 46%), with a nonstricturing, nonpenetrating behavior (71%). Time of disease was correlated with necessity of biological treatment, disease behavior, and surgical treatment (P<0.05). CONCLUSIONS: These study findings are consistent with results from other studies conducted among different populations, although a further multicentric study with a larger number of patients would be necessary to validate the Montreal Classification among Brazilian population.

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Section: Discussionmentioning

confidence: 99%

The Montreal classification for Crohn's disease: clinical application to a Brazilian single-center cohort of 90 consecutive patients

Torres

Rodrigues

Junqueira

et al. 2010

Arq. Gastroenterol.

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“…In recent years, a significant emphasis was placed on early patient stratification based upon the identifi cation of predictive factors [7] . Phenotypic classification of Crohn's disease plays an important role in deter mining treatment methodology, as it generally assists in predicting the likely clinical course [8,9] . The complex evaluation of clinical presentation, endoscopic findings, fecal, serological, and routine laboratory tests as well as early treatment factors -is recommended.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and predictors of hospitalization in Crohn’s disease in a prospective population-based inception cohort from 2000-2012

Golovics¹,

Lakatos²,

Mandel³

et al. 2015

WJG

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AIM:To analyze the prevalence, length and predictors of hospitalization in the biological era in the populationbased inception cohort from Veszprem province. METHODS:Data of 331 incident Crohn's disease (CD) patients diagnosed between January 1, 2000 and December 31, 2010 were analyzed (median age at diagnosis: 28; IQR: 21-40 years). Both in-and outpatient records were collected and comprehensively reviewed. RESULTS:Probabilities of first CD-related hospitalization and re-hospitalization were 32.3%, 45.5%, 53.7% and 13.6%, 23.9%, 29.8%, respectively after one, three and five years of follow-up in Kaplan-Meier analysis. First-year hospitalizations were related to diagnostic procedures (37%), surgery or disease activity (27% and 21%). Non-inflammatory disease behavior at diagnosis (HR = 1.32, P = 0.001) and perianal disease (HR = 1.47, P = 0.04) were associated with time to first CD-related hospitalization, while disease behavior change (HR = 2.38, P = 0.002) and need for steroids (HR = 3.14, P = 0.003) were associated with time to first re-hospitalization in multivariate analyses. Early CD-related hospitalization (within the year of diagnosis) was independently associated with need for immunosuppressives (OR = 2.08, P = 0.001) and need for surgeries (OR = 7.25, P < 0.001) during the disease course. Observational Study Prevalence and predictors of hospitalization in CONCLUSION:Hospitalization and re-hospitalization rates are still high in this cohort, especially during the first-year after the diagnosis. Non-inflammatory disease behavior at diagnosis was identified as the pivotal predictive factor of both hospitalization and rehospitalization. Core tip: Recent data on hospitalization rates in Crohn' s disease (CD) are lacking from population-based studies. In the present study our aim was to analyze the prevalence, cause and predictors of hospitalization and re-hospitalization in the population-based inception cohort from Veszprem province. Relatively high rates of CD-related hospitalizations and re-hospitalizations were found in our cohort, especially during the first year after the diagnosis. Non-inflammatory disease behavior at diagnosis, behavior change in patients with initial B1 behavior, perianal disease and total AZA and anti-TNF exposure was associated with the time to first CD-related hospitalization. Early CD-related hospitalization was associated with non-inflammatory disease behavior, perianal or internal fistulizing disease, need for immunosuppressives and need for surgeries during the disease course. Key words:Golovics PA, Lakatos L, Mandel MD, Lovasz BD, Vegh Z, Kurti Z, Szita I, Kiss LS, Pandur T, Lakatos PL. Prevalence and predictors of hospitalization in Crohn's disease in a prospective population-based inception cohort from

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“…[4][5][6][7][8]18 Smoking has also been associated with the development and progression of CD, 6,8,[12][13][14]18 increasing the risk for IBD-related surgery. Similarly, perianal disease is associated with an increased risk of progressive complicated CD [8][9][10][11] and resectional surgery.…”

Section: Discussionmentioning

confidence: 99%

“…These characteristics and outcomes may inform the clinician as to the therapeutic strategy to adopt, for example early aggressive therapy for those patients who are most likely to progress to surgery. 2,3 A range of factors have been associated with an increased risk of complicated (stricturing and penetrating) CD behaviour including the specific NOD2 genotypes [4][5][6] having had perianal disease [8][9][10][11] and cigarette smoking. 1,6,8,[12][13][14] Complicated disease is strongly associated with a requirement for surgery 15 ; therefore, knowledge of such genetic, environmental and clinical predictors may guide clinicians in developing a personalised approach for individual patients.…”

Section: Introductionmentioning

confidence: 99%

An Envirogenomic Signature Is Associated with Risk of IBD-Related Surgery in a Population-Based Crohn’s Disease Cohort

Nasir

Griffiths

Nasir

et al. 2013

Journal of Gastrointestinal Surgery

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Background and Aims Crohn's disease (CD) is an inflammatory bowel disease (IBD) caused by a combination of genetic, clinical, and environmental factors. Identification of CD patients at high risk of requiring surgery may assist clinicians to decide on a top-down or step-up treatment approach. Methods We conducted a retrospective case-control analysis of a population-based cohort of 503 CD patients. A regressionbased data reduction approach was used to systematically analyse 63 genomic, clinical and environmental factors for association with IBD-related surgery as the primary outcome variable. Results A multi-factor model was identified that yielded the highest predictive accuracy for need for surgery. The factors included in the model were the NOD2 genotype (OR=1.607, P=2.3×10 −5 ), having ever had perianal disease (OR=2.847, P=4×10 −6 ), being post-diagnosis smokers (OR=6.312, P=7.4×10 −3 ), being an ex-smoker at diagnosis (OR=2.405, P=1.1×10 −3 ) and age (OR=1.012, P=4.4×10 −3 ). Diagnostic testing for this multi-factor model produced an area under the curve of 0.681 (P=1×10 −4 ) and an odds ratio of 3.169, (95 % CI P=1×10 −4 ) which was higher than any factor considered independently.Conclusions The results of this study require validation in other populations but represent a step forward in the development of more accurate prognostic tests for clinicians to prescribe the most optimal treatment approach for complicated CD patients.

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Perianal disease, small bowel disease, smoking, prior steroid or early azathioprine/biological therapy are predictors of disease behavior change in patients with Crohn’s disease

Abstract: Our data suggest that perianal disease, small bowel disease, smoking, prior steroid use, early AZA or AZA/biological therapy are all predictors of disease behavior change in CD patients.

Cited by 100 publications

References 30 publications

The Montreal classification for Crohn's disease: clinical application to a Brazilian single-center cohort of 90 consecutive patients

The Montreal classification for Crohn's disease: clinical application to a Brazilian single-center cohort of 90 consecutive patients

Prevalence and predictors of hospitalization in Crohn’s disease in a prospective population-based inception cohort from 2000-2012

An Envirogenomic Signature Is Associated with Risk of IBD-Related Surgery in a Population-Based Crohn’s Disease Cohort

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