[Vienna classification of Crohn's disease: helpful or dispensable? A critical view].
A short review of phenotypic classification of Crohn's disease is given. Pitfalls in a clinical system of disease classification into different phenotypes and limitations of the Vienna classification of Crohn's disease are discussed. The concept of distinctive patterns of disease "behaviour" is criticized. The disease behaviour is not a persistent phenomenon and changes in the long-term follow-up significantly. Factors not addressed in the Vienna classification but, of course, influencing presentation and progression of Crohn's disease such as influences of early childhood, smoking and use of non-steroidal anti-inflammatory drugs are mentioned. The need of the classification criterion "age" is questioned. It is criticized that the Vienna classification has (at least until now) no consequences for the management of Crohn's disease. Experimental treatment approaches follow the current genetic or microbiological hypotheses and do not consider the Vienna classification system. In view of the philosophy of science the need of phenotypic classification into subgroups, clarification of mechanisms and experimentation with drug treatments in the elaboration of disease causation is stressed. In recent years much progress has been made in clarifying Kirsner's "mysterious and multiplex" nature of inflammatory bowel disease. However, as physicians we have to focus on the "menace" of a chronic disease for the patient's life and not only to treat the hole of the patient with "biologicals" but rather to treat the whole patient in a bio-psycho-social approach.
Leiss
O
O
Gastroenterologische Gemeinschaftspraxis, Bahnhofplatz 2, 55116 Mainz. OLeiss@aol.com
Börner
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N
D003424:Crohn Disease / Q000145:classification* / Q000175:diagnosis* / Q000235:genetics; D020022:Genetic Predisposition to Disease / Q000235:genetics; D006801:Humans; D053473:Nod2 Signaling Adaptor Protein / Q000235:genetics; D010641:Phenotype
C429018:NOD2 protein, human; D053473:Nod2 Signaling Adaptor Protein