title: [Different approaches for medical or surgical management of Crohn's disease: the importance of the classification of Vienna].
abstract: The Vienna classification of Crohn's disease provides defined criteria for a phenotypic classification of the disease, considering that phenotypic parameters reflect the contribution of both genetic and environmental factors to the expression of disease. The classification includes mainly three criteria as part of the natural course of disease: age at the diagnosis, location and behaviour and it provides distinct definitions to categorize Crohn' patients into 24 subgroups. In this study we attempt to define the clinical importance of the Vienna classification and the possibility to optimize medical care of Crohn's disease according to patient subgroups. Early age at the diagnosis is associated with a greater prevalence of a family history, greater small bowel involvement, more complicated stricturing disease and a higher frequency of surgery. Surgery is based on exact knowledge of location: L1 patients might profit the most from resective surgery, L4 patients from strictureplasty. Stricturing behaviour (B2) might be the most appropriate subgroup for surgical treatment. Penetrating behaviour (B3) is confirmed as an important risk for early postoperative recurrence; patients in the penetrating behaviour group (i.e. fistulas) have a specific indication for immunosuppressive or anti-tumour necrosis factor-alpha therapy.
authors.affiliation: Dipartimento di Scienze Chirurgiche e dei Trapianti d'Organo, Istituto di Chirurgia Generale Gastroenterologica e Mammaria, Università degli Studi di Pavia, IRCCS Policlinico San Matteo--Pavia.
authors.forename: Paolo Luigi
authors.initials: PL
authors.lastname: Colombo
authors.forename: Mario
authors.initials: M
authors.lastname: Benedetti
authors.forename: Francesco Paolo
authors.initials: FP
authors.lastname: Tinozzi
authors.forename: Elena
authors.initials: E
authors.lastname: Ticozzelli
authors.forename: Nirvana
authors.initials: N
authors.lastname: Maroni
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Sabatino
authors.forename: Stefano
authors.initials: S
authors.lastname: Tinozzi
mesh_terms: D003424:Crohn Disease / Q000145:classification / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D010641:Phenotype; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha