Clinical practice in Crohn's disease in bordering regions of two countries: different medical options, distinct surgical events.
Contemplating the multifactorial nature of Crohn's disease (CD), the purpose of this study was to compare two neighbouring CD populations from different nations and examine how clinical characteristics of patients can influence therapeutic strategies and consequently different surgical events in routine clinical practice. Cross-sectional study based on data of an on-line registry of patients with CD in northern Portugal and Galicia. Of the 1238 patients, all with five or more years of disease, 568 (46%) were male and 670 (54%) female. The Portuguese and Galician populations were similar regarding Montreal categories, age at diagnosis, and years of follow-up. Galician B2 patients were associated with immunosuppression (OR 3.6; CI 2.2-6.1) and biologic treatment (OR 1.8; CI 1.0-3.1). In both populations ileocolonic disease was associated with immunosuppression and biologic treatment and the penetrating group was linked to immunosuppression. In the north of Portugal 47% and 16% of patients, and in Galicia 63% and 33%, were treated with immunosuppressants and biologic treatment, respectively. In the north of Portugal 44% of patients classified as stricturing behavior were operated without immunomodulation, in contrast to 12% in Galicia. In the latter it was possible to maintain 16% of B2 patients and 40% of B3 patients without surgery with adequate immunosuppression and/or biologic treatment. The delta of surgeries in B2 patients was 8% and in B3 26%.


CONCLUSIONS
Stratifying patients according to the Montreal classification identified similar clinical patterns in disparate geographic populations, and revealed that differing medical therapeutic practices may influence the occurrence of surgical events.
Portuguese Group of Studies of Inflammatory Bowel Diseases, Portugal. fm@med.up.pt
Fernando
F
Magro
Manuel
M
Barreiro-de Acosta
Paula
P
Lago
Daniel
D
Carpio
José
J
Cotter
Ana
A
Echarri
Raquel
R
Gonçalves
Santos
S
Pereira
Laura
L
Carvalho
Aurelio
A
Lorenzo
Luisa
L
Barros
Javier
J
Castro
Jorge Amil
JA
Dias
Susana
S
Rodrigues
Francisco
F
Portela
Camila
C
Dias
Altamiro
A
da Costa-Pereira
D000005:Abdomen / Q000601:surgery; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001691:Biological Therapy / Q000706:statistics & numerical data; D003424:Crohn Disease / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000706:statistics & numerical data; D007422:Intestines / Q000601:surgery; D008297:Male; D015999:Multivariate Analysis; D011174:Portugal / Q000453:epidemiology; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D055815:Young Adult