Crohn's disease in a southern European country: Montreal classification and clinical activity.
BACKGROUND
Given the heterogeneous nature of Crohn's disease (CD), our aim was to apply the Montreal Classification to a large cohort of Portuguese patients with CD in order to identify potential predictive regarding the need for medical and/or surgical treatment.


METHODS
A cross-sectional study was used based on data from an on-line registry of patients with CD.


RESULTS
Of the 1692 patients with 5 or more years of disease, 747 (44%) were male and 945 (56%) female. On multivariate analysis the A2 group was an independent risk factor of the need for steroids (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.1-2.3) and the A1 and A2 groups for immunosuppressants (OR 2.2; CI 1.2-3.8; OR 1.4; CI 1.0-2.0, respectively). An L3+L3(4) and L(4) location were risk factors for immunosuppression (OR 1.9; CI 1.5-2.4), whereas an L1 location was significantly associated with the need for abdominal surgery (P < 0.001). After 20 years of disease, less than 10% of patients persisted without steroids, immunosuppression, or surgery. The Montreal Classification allowed us to identify different groups of disease severity: A1 were more immunosuppressed without surgery, most of A2 patients were submitted to surgery, and 52% of L1+L1(4) patients were operated without immunosuppressants.


CONCLUSIONS
Stratifying patients according to the Montreal Classification may prove useful in identifying different phenotypes with different therapies and severity. Most of our patients have severe disease.
Magro
Fernando
F
Portuguese Group of Studies of Inflammatory Bowel Diseases, Oporto University, Porto, Portugal. fm@med.up.pt
Portela
Francisco
F
Lago
Paula
P
Ramos de Deus
João
J
Vieira
Ana
A
Peixe
Paula
P
Cremers
Isabelle
I
Cotter
José
J
Cravo
Marília
M
Tavares
Lourdes
L
Reis
Jorge
J
Gonçalves
Raquel
R
Lopes
Horácio
H
Caldeira
Paulo
P
Ministro
Paula
P
Carvalho
Laura
L
Azevedo
Luis
L
da Costa-Pereira
Altamiro
A
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D015331:Cohort Studies; D003424:Crohn Disease / Q000145:classification* / Q000188:drug therapy / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005060:Europe; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011174:Portugal / Q000453:epidemiology; D012042:Registries; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
D007166:Immunosuppressive Agents