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Arieira C, Cúrdia Gonçaves T, Dias de Castro F, João Moreira M, Cotter J. Clinical course in Crohn's disease: factors associated with behaviour change and surgery. Scand J Gastroenterol 2019; 53:1222-1227. [PMID: 30345845 DOI: 10.1080/00365521.2018.1503709] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
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 = .049), age at diagnosis <16 years (8.7% vs. 2.0%; p = .017), the use of steroids at diagnosis (43.2% vs. 27.0%; p = .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 = .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.
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Affiliation(s)
- Cátia Arieira
- a Gastroenterology Department , Hospital da Senhora da Oliveira , Guimarães , Portugal.,b School of Medicine, Life and Health Sciences Research Institute, University of Minho , Braga/Guimarães , Portugal.,c ICVS/3B's, PT Government Associate Laboratory , Braga/Guimarães , Portugal
| | - Tiago Cúrdia Gonçaves
- a Gastroenterology Department , Hospital da Senhora da Oliveira , Guimarães , Portugal.,b School of Medicine, Life and Health Sciences Research Institute, University of Minho , Braga/Guimarães , Portugal.,c ICVS/3B's, PT Government Associate Laboratory , Braga/Guimarães , Portugal
| | - Francisca Dias de Castro
- a Gastroenterology Department , Hospital da Senhora da Oliveira , Guimarães , Portugal.,b School of Medicine, Life and Health Sciences Research Institute, University of Minho , Braga/Guimarães , Portugal.,c ICVS/3B's, PT Government Associate Laboratory , Braga/Guimarães , Portugal
| | - Maria João Moreira
- a Gastroenterology Department , Hospital da Senhora da Oliveira , Guimarães , Portugal.,b School of Medicine, Life and Health Sciences Research Institute, University of Minho , Braga/Guimarães , Portugal.,c ICVS/3B's, PT Government Associate Laboratory , Braga/Guimarães , Portugal
| | - José Cotter
- a Gastroenterology Department , Hospital da Senhora da Oliveira , Guimarães , Portugal.,b School of Medicine, Life and Health Sciences Research Institute, University of Minho , Braga/Guimarães , Portugal.,c ICVS/3B's, PT Government Associate Laboratory , Braga/Guimarães , Portugal
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