Evolution of Clinical Behavior in Crohn’s Disease: Factors Associated with Complicated Disease and Surgery
Background The phenotypic expression of Crohn’s disease may vary over time. Establishment of Crohn’s disease phenotypes is important for definition of patient care strategies. Aims The aim of the study was to evaluate the long-term evolution of patients based on disease phenotypes and the main facto...
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| Veröffentlicht in: | Digestive diseases and sciences 2017-09, Vol.62 (9), p.2481-2488 |
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| creator | de Barros, Kátia Simone Cezário Flores, Cristina Harlacher, Luciana Francesconi, Carlos Fernando Magalhães |
| description | Background
The phenotypic expression of Crohn’s disease may vary over time. Establishment of Crohn’s disease phenotypes is important for definition of patient care strategies.
Aims
The aim of the study was to evaluate the long-term evolution of patients based on disease phenotypes and the main factors associated with this evolution.
Methods
Data from 179 patients were collected from a unicentric prospective database. Montreal classification was employed. Kaplan–Meier method was used to estimate the cumulative probability of complication development and surgery. Poisson regression for multivariate analysis was applied. The Local Institutional Review Board approved the research.
Results
Female: 54.2%. Mean age at diagnosis: 32.7 (±13.7) years. Behavior at presentation: inflammatory 62.0%, stricturing 24.6%, penetrating 13.4%; perianal disease: 31.8%; median follow-up time: 65.2 months (IQR 31.0–108.8). Behavior at follow-up period end: inflammatory 43.6%, stricturing 38.0%, penetrating 18.4%; perianal disease: 46.4%. Cumulative probability of being complication free in 5, 10, and 20 years: 86.3, 66.4, and 52.2%, respectively. Cumulative probability of being surgery free in 5, 10, and 20 years: 87.3, 79.2, and 64.1%, respectively. L1 and L4 locations, use of immunosuppressive therapy, smoking, number of hospitalization/patient-year, abdominal surgery, age at diagnosis |
| doi_str_mv | 10.1007/s10620-017-4685-9 |
| format | Article |
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The phenotypic expression of Crohn’s disease may vary over time. Establishment of Crohn’s disease phenotypes is important for definition of patient care strategies.
Aims
The aim of the study was to evaluate the long-term evolution of patients based on disease phenotypes and the main factors associated with this evolution.
Methods
Data from 179 patients were collected from a unicentric prospective database. Montreal classification was employed. Kaplan–Meier method was used to estimate the cumulative probability of complication development and surgery. Poisson regression for multivariate analysis was applied. The Local Institutional Review Board approved the research.
Results
Female: 54.2%. Mean age at diagnosis: 32.7 (±13.7) years. Behavior at presentation: inflammatory 62.0%, stricturing 24.6%, penetrating 13.4%; perianal disease: 31.8%; median follow-up time: 65.2 months (IQR 31.0–108.8). Behavior at follow-up period end: inflammatory 43.6%, stricturing 38.0%, penetrating 18.4%; perianal disease: 46.4%. Cumulative probability of being complication free in 5, 10, and 20 years: 86.3, 66.4, and 52.2%, respectively. Cumulative probability of being surgery free in 5, 10, and 20 years: 87.3, 79.2, and 64.1%, respectively. L1 and L4 locations, use of immunosuppressive therapy, smoking, number of hospitalization/patient-year, abdominal surgery, age at diagnosis <40 years, and biological therapy were the factors associated with changes in phenotype or development of complications and perianal disease.
Conclusion
Clinical behavior altered in about one-third of patients. The most frequent complication was a change to stricturing pattern. Disease location, current smoker, immunosuppressive therapy use, hospitalization, and abdominal surgery were factors associated with an unfavorable clinical evolution.</description><identifier>ISSN: 0163-2116</identifier><identifier>EISSN: 1573-2568</identifier><identifier>DOI: 10.1007/s10620-017-4685-9</identifier><identifier>PMID: 28748409</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal surgery ; Adult ; Biochemistry ; Brazil - epidemiology ; Care and treatment ; Cohort Studies ; Crohn Disease - diagnosis ; Crohn Disease - epidemiology ; Crohn Disease - surgery ; Crohn's disease ; Epidemiology ; Female ; Follow-Up Studies ; Gastroenterology ; Hepatology ; Humans ; Immunotherapy ; Male ; Medical research ; Medicine ; Medicine & Public Health ; Medicine, Experimental ; Middle Aged ; Multivariate analysis ; Oncology ; Original Article ; Patients ; Phenotype ; Prospective Studies ; Retrospective Studies ; Risk Factors ; Surgery ; Transplant Surgery ; Young Adult</subject><ispartof>Digestive diseases and sciences, 2017-09, Vol.62 (9), p.2481-2488</ispartof><rights>Springer Science+Business Media, LLC 2017</rights><rights>COPYRIGHT 2017 Springer</rights><rights>Digestive Diseases and Sciences is a copyright of Springer, 2017.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c439t-834d8082e2bcdbfff447bb3e1cb90547c6c7347b6a20627035bac67cd38cdb323</citedby><cites>FETCH-LOGICAL-c439t-834d8082e2bcdbfff447bb3e1cb90547c6c7347b6a20627035bac67cd38cdb323</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10620-017-4685-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10620-017-4685-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28748409$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>de Barros, Kátia Simone Cezário</creatorcontrib><creatorcontrib>Flores, Cristina</creatorcontrib><creatorcontrib>Harlacher, Luciana</creatorcontrib><creatorcontrib>Francesconi, Carlos Fernando Magalhães</creatorcontrib><title>Evolution of Clinical Behavior in Crohn’s Disease: Factors Associated with Complicated Disease and Surgery</title><title>Digestive diseases and sciences</title><addtitle>Dig Dis Sci</addtitle><addtitle>Dig Dis Sci</addtitle><description>Background
The phenotypic expression of Crohn’s disease may vary over time. Establishment of Crohn’s disease phenotypes is important for definition of patient care strategies.
Aims
The aim of the study was to evaluate the long-term evolution of patients based on disease phenotypes and the main factors associated with this evolution.
Methods
Data from 179 patients were collected from a unicentric prospective database. Montreal classification was employed. Kaplan–Meier method was used to estimate the cumulative probability of complication development and surgery. Poisson regression for multivariate analysis was applied. The Local Institutional Review Board approved the research.
Results
Female: 54.2%. Mean age at diagnosis: 32.7 (±13.7) years. Behavior at presentation: inflammatory 62.0%, stricturing 24.6%, penetrating 13.4%; perianal disease: 31.8%; median follow-up time: 65.2 months (IQR 31.0–108.8). Behavior at follow-up period end: inflammatory 43.6%, stricturing 38.0%, penetrating 18.4%; perianal disease: 46.4%. Cumulative probability of being complication free in 5, 10, and 20 years: 86.3, 66.4, and 52.2%, respectively. Cumulative probability of being surgery free in 5, 10, and 20 years: 87.3, 79.2, and 64.1%, respectively. L1 and L4 locations, use of immunosuppressive therapy, smoking, number of hospitalization/patient-year, abdominal surgery, age at diagnosis <40 years, and biological therapy were the factors associated with changes in phenotype or development of complications and perianal disease.
Conclusion
Clinical behavior altered in about one-third of patients. The most frequent complication was a change to stricturing pattern. Disease location, current smoker, immunosuppressive therapy use, hospitalization, and abdominal surgery were factors associated with an unfavorable clinical evolution.</description><subject>Abdominal surgery</subject><subject>Adult</subject><subject>Biochemistry</subject><subject>Brazil - epidemiology</subject><subject>Care and treatment</subject><subject>Cohort Studies</subject><subject>Crohn Disease - diagnosis</subject><subject>Crohn Disease - epidemiology</subject><subject>Crohn Disease - surgery</subject><subject>Crohn's disease</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastroenterology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Immunotherapy</subject><subject>Male</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Medicine, Experimental</subject><subject>Middle Aged</subject><subject>Multivariate analysis</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Patients</subject><subject>Phenotype</subject><subject>Prospective Studies</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Surgery</subject><subject>Transplant Surgery</subject><subject>Young Adult</subject><issn>0163-2116</issn><issn>1573-2568</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kctu1DAUhi0EokPhAdggS2zYpPgWX9gNoQWkSiyAteU4TseVYw92UtQdr8Hr8SQ4muEqkBe2jr__1znnB-AxRmcYIfG8YMQJahAWDeOybdQdsMGtoA1pubwLNgjz-saYn4AHpVwjhJTA_D44IVIwyZDagHB-k8Iy-xRhGmEXfPTWBPjS7cyNTxn6CLucdvHbl68FvvLFmeJewAtj55QL3JaSrDezG-BnP-9gl6Z9qAZr4QhDEwf4fslXLt8-BPdGE4p7dLxPwceL8w_dm-by3eu33faysYyquZGUDRJJ4khvh34cR8ZE31OHba9Qy4TlVtBa4obU-QWibW8sF3agsvKU0FPw7OC7z-nT4sqsJ1-sC8FEl5aisSKslUqRFX36F3qdlhxrdyulqJKtFL-oKxOc9nFMczZ2NdVbgSsmEV69zv5B1TO4ydsU3ehr_Q8BPghsTqVkN-p99pPJtxojvSasDwnrmrBeE9aqap4cG176yQ0_FT8irQA5AKV-xbr23yb6r-t3EC6wCQ</recordid><startdate>20170901</startdate><enddate>20170901</enddate><creator>de Barros, Kátia Simone Cezário</creator><creator>Flores, Cristina</creator><creator>Harlacher, Luciana</creator><creator>Francesconi, Carlos Fernando Magalhães</creator><general>Springer US</general><general>Springer</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20170901</creationdate><title>Evolution of Clinical Behavior in Crohn’s Disease: Factors Associated with Complicated Disease and Surgery</title><author>de Barros, Kátia Simone Cezário ; Flores, Cristina ; Harlacher, Luciana ; Francesconi, Carlos Fernando Magalhães</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c439t-834d8082e2bcdbfff447bb3e1cb90547c6c7347b6a20627035bac67cd38cdb323</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Abdominal surgery</topic><topic>Adult</topic><topic>Biochemistry</topic><topic>Brazil - epidemiology</topic><topic>Care and treatment</topic><topic>Cohort Studies</topic><topic>Crohn Disease - diagnosis</topic><topic>Crohn Disease - epidemiology</topic><topic>Crohn Disease - surgery</topic><topic>Crohn's disease</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gastroenterology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Immunotherapy</topic><topic>Male</topic><topic>Medical research</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Medicine, Experimental</topic><topic>Middle Aged</topic><topic>Multivariate analysis</topic><topic>Oncology</topic><topic>Original Article</topic><topic>Patients</topic><topic>Phenotype</topic><topic>Prospective Studies</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Surgery</topic><topic>Transplant Surgery</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>de Barros, Kátia Simone Cezário</creatorcontrib><creatorcontrib>Flores, Cristina</creatorcontrib><creatorcontrib>Harlacher, Luciana</creatorcontrib><creatorcontrib>Francesconi, Carlos Fernando Magalhães</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Digestive diseases and sciences</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>de Barros, Kátia Simone Cezário</au><au>Flores, Cristina</au><au>Harlacher, Luciana</au><au>Francesconi, Carlos Fernando Magalhães</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evolution of Clinical Behavior in Crohn’s Disease: Factors Associated with Complicated Disease and Surgery</atitle><jtitle>Digestive diseases and sciences</jtitle><stitle>Dig Dis Sci</stitle><addtitle>Dig Dis Sci</addtitle><date>2017-09-01</date><risdate>2017</risdate><volume>62</volume><issue>9</issue><spage>2481</spage><epage>2488</epage><pages>2481-2488</pages><issn>0163-2116</issn><eissn>1573-2568</eissn><abstract>Background
The phenotypic expression of Crohn’s disease may vary over time. Establishment of Crohn’s disease phenotypes is important for definition of patient care strategies.
Aims
The aim of the study was to evaluate the long-term evolution of patients based on disease phenotypes and the main factors associated with this evolution.
Methods
Data from 179 patients were collected from a unicentric prospective database. Montreal classification was employed. Kaplan–Meier method was used to estimate the cumulative probability of complication development and surgery. Poisson regression for multivariate analysis was applied. The Local Institutional Review Board approved the research.
Results
Female: 54.2%. Mean age at diagnosis: 32.7 (±13.7) years. Behavior at presentation: inflammatory 62.0%, stricturing 24.6%, penetrating 13.4%; perianal disease: 31.8%; median follow-up time: 65.2 months (IQR 31.0–108.8). Behavior at follow-up period end: inflammatory 43.6%, stricturing 38.0%, penetrating 18.4%; perianal disease: 46.4%. Cumulative probability of being complication free in 5, 10, and 20 years: 86.3, 66.4, and 52.2%, respectively. Cumulative probability of being surgery free in 5, 10, and 20 years: 87.3, 79.2, and 64.1%, respectively. L1 and L4 locations, use of immunosuppressive therapy, smoking, number of hospitalization/patient-year, abdominal surgery, age at diagnosis <40 years, and biological therapy were the factors associated with changes in phenotype or development of complications and perianal disease.
Conclusion
Clinical behavior altered in about one-third of patients. The most frequent complication was a change to stricturing pattern. Disease location, current smoker, immunosuppressive therapy use, hospitalization, and abdominal surgery were factors associated with an unfavorable clinical evolution.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>28748409</pmid><doi>10.1007/s10620-017-4685-9</doi><tpages>8</tpages></addata></record> |
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| identifier | ISSN: 0163-2116 |
| ispartof | Digestive diseases and sciences, 2017-09, Vol.62 (9), p.2481-2488 |
| issn | 0163-2116 1573-2568 |
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| source | MEDLINE; Springer Journals |
| subjects | Abdominal surgery Adult Biochemistry Brazil - epidemiology Care and treatment Cohort Studies Crohn Disease - diagnosis Crohn Disease - epidemiology Crohn Disease - surgery Crohn's disease Epidemiology Female Follow-Up Studies Gastroenterology Hepatology Humans Immunotherapy Male Medical research Medicine Medicine & Public Health Medicine, Experimental Middle Aged Multivariate analysis Oncology Original Article Patients Phenotype Prospective Studies Retrospective Studies Risk Factors Surgery Transplant Surgery Young Adult |
| title | Evolution of Clinical Behavior in Crohn’s Disease: Factors Associated with Complicated Disease and Surgery |
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