Long-term evolution of disease behavior of Crohn's disease.
BACKGROUND
The Vienna classification of Crohn's disease (CD) distinguishes three patient subgroups according to disease behavior: stricturing, penetrating, and inflammatory. Our aim was to assess the long-term evolution of the disease behavior of CD and to determine the predictive factors and prognostic implications of this evolution.


METHODS
Occurrence and predictive factors of a stricturing and/or a penetrating complication were searched for in 2,002 patients with CD studied retrospectively. In addition, the 1995-2000 disease course was assessed prospectively in a cohort of 646 patients with disease duration >5 years, classified according to their previous disease behavior.


RESULTS
1,199 patients (60%) developed a stricturing (n = 254) or a penetrating (n = 945) complication. Twenty-year actuarial rates of inflammatory, stricturing, and penetrating disease were 12, 18, and 70%, respectively. The initial location of lesions was the main determinant of the time and type of the complication. In the cohort study, year-by-year activity and therapeutic requirements did not show significant sustained differences between behavioral subgroups.


CONCLUSIONS
Most patients with CD will eventually one day develop a stricturing or a perforating complication. Initial location determines the type of the complication. Classification of patients into a behavioral group from previous history has no impact upon activity during the following years.
Cosnes
Jacques
J
Service d'Hépatogastroentérologie et Nutrition, Hôpital Rothschild, Paris, France. jacques.cosnes@rth.ap-hop-paris.fr
Cattan
Stéphane
S
Blain
Antoine
A
Beaugerie
Laurent
L
Carbonnel
Franck
F
Parc
Rolland
R
Gendre
Jean-Pierre
JP
D000038:Abscess / Q000209:etiology / Q000473:pathology; D000328:Adult; D015331:Cohort Studies; D003424:Crohn Disease / Q000145:classification / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007249:Inflammation; D007416:Intestinal Perforation / Q000209:etiology* / Q000473:pathology; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index