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Gut 2006;55:1124-1130 doi:10.1136/gut.2005.084061
  • Inflammatory bowel disease

Phenotype at diagnosis predicts recurrence rates in Crohn’s disease

  1. F L Wolters1,
  2. M G Russel2,
  3. J Sijbrandij3,
  4. T Ambergen4,
  5. S Odes5,
  6. L Riis6,
  7. E Langholz6,
  8. P Politi7,
  9. A Qasim8,
  10. I Koutroubakis9,
  11. E Tsianos10,
  12. S Vermeire11,
  13. J Freitas12,
  14. G van Zeijl3,
  15. O Hoie13,
  16. T Bernklev13,
  17. M Beltrami14,
  18. D Rodriguez15,
  19. R W Stockbrügger1,
  20. B Moum13,
  21. on behalf of the European Collaborative Study Group on Inflammatory Bowel Disease (EC-IBD)
  1. 1Department of Gastroenterology and Hepatology, University Hospital Maastricht, Maastricht, the Netherlands
  2. 2Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, the Netherlands
  3. 3MEMIC, Centre for Data and Information Management, University of Maastricht, Maastricht, the Netherlands
  4. 4Department of Methodology and Statistics, University of Maastricht, Maastricht, the Netherlands
  5. 5Gastroenterology Unit, Soroka University Hospital, Ben Gurion University of the Negev, Beer Sheva, Israel
  6. 6Medical Department, Herlev Hospital, University of Copenhagen, Herlev, Denmark
  7. 7Servizio di Gastroenterologia, Ospedale di Cremona, Cremona, Italy
  8. 8Adelaide and Meath Hospital, Department of Gastroenterology, Trinity College, Tallaght, Dublin, Ireland
  9. 9Department of Gastroenterology, University General Hospital, Heraklion, Crete, Greece
  10. 10Division of Internal Medicine, University of Ioannina, Ioannina, Greece
  11. 11Department of Gastroenterology, UZ Gasthuisberg, University of Leuven, Leuven, Belgium
  12. 12Department of Gastroenterology, Almada Regional Health Department, Portugal
  13. 13Oestfold Central Hospital, Department of Medicine, Section for Gastroenterology, Fredrikstad, Norway
  14. 14Arcispedale S Maria Nuova Azienda Ospedaliera, Reggio Emilia, Italy
  15. 15Hospital Xeral de Vigo, Vigo, Spain
  1. Correspondence to:
    Dr F L Wolters
    Department of Gastroenterology and Hepatology, PO Box 5800, 6202 AZ Maastricht, the Netherlands; frankwolters{at}ace-on-air.nl
  • Accepted 10 December 2005
  • Revised 7 December 2005
  • Published Online First 16 December 2005

Abstract

Background: In Crohn’s disease (CD), studies associating phenotype at diagnosis and subsequent disease activity are important for patient counselling and health care planning.

Aims: To calculate disease recurrence rates and to correlate these with phenotypic traits at diagnosis.

Methods: A prospectively assembled uniformly diagnosed European population based inception cohort of CD patients was classified according to the Vienna classification for disease phenotype at diagnosis. Surgical and non-surgical recurrence rates throughout a 10 year follow up period were calculated. Multivariate analysis was performed to classify risk factors present at diagnosis for recurrent disease.

Results: A total of 358 were classified for phenotype at diagnosis, of whom 262 (73.2%) had a first recurrence and 113 patients (31.6%) a first surgical recurrence during the first 10 years after diagnosis. Patients with upper gastrointestinal disease at diagnosis had an excess risk of recurrence (hazard ratio 1.54 (95% confidence interval (CI) 1.13–2.10)) whereas age ≥40 years at diagnosis was protective (hazard ratio 0.82 (95% CI 0.70–0.97)). Colonic disease was a protective characteristic for resective surgery (hazard ratio 0.38 (95% CI 0.21–0.69)). More frequent resective surgical recurrences were reported from Copenhagen (hazard ratio 3.23 (95% CI 1.32–7.89)).

Conclusions: A mild course of disease in terms of disease recurrence was observed in this European cohort. Phenotype at diagnosis had predictive value for disease recurrence with upper gastrointestinal disease being the most important positive predictor. A phenotypic North-South gradient in CD may be present, illustrated by higher surgery risks in some of the Northern European centres.

Footnotes

  • Published online first 16 December 2005

  • This study was granted by the European Commission as a fifth framework shared cost action (QLG4-CT-2000-01414)

  • Conflict of interest: None declared.

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