Factors associated with disease evolution in Greek patients with inflammatory bowel disease.
BACKGROUND
The majority of Crohn's disease patients with B1 phenotype at diagnosis (i.e. non-stricturing non-penetrating disease) will develop over time a stricturing or a penetrating pattern. Conflicting data exist on the rate of proximal disease extension in ulcerative colitis patients with proctitis or left-sided colitis at diagnosis. We aimed to study disease evolution in Crohn's disease B1 patients and ulcerative colitis patients with proctitis and left-sided colitis at diagnosis.


METHODS
116 Crohn's disease and 256 ulcerative colitis patients were followed-up for at least 5 years after diagnosis. Crohn's disease patients were classified according to the Vienna criteria. Data were analysed actuarially.


RESULTS
B1 phenotype accounted for 68.9% of Crohn's disease patients at diagnosis. The cumulative probability of change in disease behaviour in B1 patients was 43.6% at 10 years after diagnosis. Active smoking (Hazard Ratio: 3.01) and non-colonic disease (non-L2) (Hazard Ratio: 3.01) were associated with behavioural change in B1 patients. Proctitis and left-sided colitis accounted for 24.2%, and 48.4% of ulcerative colitis patients at diagnosis. The 10 year cumulative probability of proximal disease extension in patients with proctitis and left-sided colitis was 36.8%, and 17.1%, respectively (p: 0.003). Among proctitis patients, proximal extension was more common in non-smokers (Hazard Ratio: 4.39).


CONCLUSIONS
Classification of Crohn's disease patients in B1 phenotype should be considered as temporary. Smoking and non-colonic disease are risk factors for behavioural change in B1 Crohn's disease patients. Proximal extension is more common in ulcerative colitis patients with proctitis than in those with left-sided colitis. Among proctitis patients, proximal extension is more common in non-smokers.
Chatzicostas
Constantinos
C
Department of Gastroenterology, General Hospital of Rethymnon, Rethymnon, Crete, Greece. matrix01gr@yahoo.gr
Roussomoustakaki
Maria
M
Potamianos
Spiros
S
Paspatis
Gregorios
G
Mouzas
Ioannis
I
Romanos
John
J
Mavrogeni
Helen
H
Kouroumalis
Elias
E
D000328:Adult; D001521:Behavior Therapy; D003093:Colitis, Ulcerative / Q000145:classification / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology*; D003424:Crohn Disease / Q000145:classification / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006115:Greece; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010641:Phenotype; D011349:Proctitis / Q000150:complications; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000523:psychology