title: Treatment inferred disease severity in Crohn's disease: evidence for a European gradient of disease course.
abstract: OBJECTIVE
  Geographic differences in disease course of Crohn's disease (CD) might possibly be related to differences in genetic and environmental factors encountered in different parts of the world. The aim of this study was to assess differences in treatment regimens within a European cohort of CD patients as a reflection of disease course, and to identify associated phenotypic risk factors at diagnosis.
  
  
  METHODS
  A prospective European population-based inception cohort of 380 CD patients was studied. The patients were classified for phenotype according to the Vienna classification. Differences between Northern and Southern European centres in treatment over the first 10 years of disease were analysed using a competing risks survival analysis method.
  
  
  RESULTS
  Patients in the North were more likely to have had surgery (p<0.01), whereas patients in the South were more likely to have been treated medically (p<0.01). Phenotype at diagnosis was not predictive of differences in treatment regimens between North and South.
  
  
  CONCLUSIONS
  In this study, a difference in management of CD was observed between Northern and Southern European centres. This suggests that there may be a North-South disease severity gradient across Europe. Phenotypic differences between patients in the North and South did not explain this observed difference.
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital Maastricht, Maastricht, The Netherlands. frankwolters@ace-on-air.nl
authors.forename: Frank L
authors.initials: FL
authors.lastname: Wolters
authors.forename: Catelijne
authors.initials: C
authors.lastname: Joling
authors.forename: Maurice G
authors.initials: MG
authors.lastname: Russel
authors.forename: Jildou
authors.initials: J
authors.lastname: Sijbrandij
authors.forename: Marion
authors.initials: M
authors.lastname: De Bruin
authors.forename: Selwyn
authors.initials: S
authors.lastname: Odes
authors.forename: Lene
authors.initials: L
authors.lastname: Riis
authors.forename: Pia
authors.initials: P
authors.lastname: Munkholm
authors.forename: Paolo
authors.initials: P
authors.lastname: Bodini
authors.forename: Barbara
authors.initials: B
authors.lastname: Ryan
authors.forename: Colm
authors.initials: C
authors.lastname: O'Morain
authors.forename: Ioannis A
authors.initials: IA
authors.lastname: Mouzas
authors.forename: Epameinondas
authors.initials: E
authors.lastname: Tsianos
authors.forename: Severine
authors.initials: S
authors.lastname: Vermeire
authors.forename: Estela
authors.initials: E
authors.lastname: Monteiro
authors.forename: Charles
authors.initials: C
authors.lastname: Limonard
authors.forename: Morten
authors.initials: M
authors.lastname: Vatn
authors.forename: Giovanni
authors.initials: G
authors.lastname: Fornaciari
authors.forename: Dolores
authors.initials: D
authors.lastname: Rodriguez
authors.forename: Wim
authors.initials: W
authors.lastname: Groot
authors.forename: Bjørn
authors.initials: B
authors.lastname: Moum
authors.forename: Reinhold W
authors.initials: RW
authors.lastname: Stockbrügger
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D015986:Confounding Factors, Epidemiologic; D003424:Crohn Disease / Q000188:drug therapy / Q000453:epidemiology* / Q000235:genetics; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D019456:Health Transition; D006801:Humans; D008297:Male; D010641:Phenotype; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D012737:Sex Factors; D016019:Survival Analysis