title: Temporal Change in Phenotypic Behaviour in Patients with Crohn's Disease: Do Indian Patients Behave Differently from Western and Other Asian Patients?
abstract: OBJECTIVE
  In Western studies, one-third of patients with Crohn's disease have stricturing or penetrating disease at presentation and one-half will progress to complicated disease in 20 years. Asian studies indicate that the Asian disease phenotype may be different. Our aim was to study the disease behaviour in Indian patients with Crohn's disease.
  
  
  METHODS
  In this hospital-based study, we analysed [Montreal classification] disease phenotype, presence of perianal disease, need for intestinal surgery, and changes in the Montreal classification over time in Crohn's disease patients from our database.
  
  
  RESULTS
  In the 178 patients (median age 35, interquartile range [IQR] 21 years; 97 males) with Crohn's disease, the proportion of various features was as follows. More patients had ileo-colonic[L3: 43.8%] than ileal[L1: 27.5%] or colonic[L2: 28.7%] disease. Perianal disease was seen in 11.8% at baseline. Non-stricturing, non-fistulising disease[B1] was seen in 74.7%, 65.7%, 50%, and 44.4% at baseline, at 5, 10 and 15 years, respectively. Stricturing disease[B2] was seen in 21.4%, 21.9%, 28.9%, and 33.3%; penetrating disease[B3] in 3.9%, 11.4%, 21%, and 16.7%; and intestinal surgery was required in 10.7%, 20%, 34.2%, and 55.5%, respectively. KaplanMeier analysis showed no association between progression of disease and patient age or the location of the disease.
  
  
  CONCLUSIONS
  Gender distribution and predominant ileo-colonic location of disease were similar to earlier Asian reports on Crohn's disease. Perianal disease was less frequent than reported in Western and other Asian studies. One-fourth of Indian patients had aggressive disease at diagnosis, but the tendency to progress towards aggressive disease over time was less pronounced than in Western patients.
authors.affiliation: Division of Gastroenterology, P D Hinduja Hospital, Mumbai, India.
authors.forename: Rishikesh
authors.initials: R
authors.lastname: Kalaria
authors.affiliation: Division of Gastroenterology, P D Hinduja Hospital, Mumbai, India.
authors.forename: Devendra
authors.initials: D
authors.lastname: Desai
authors.affiliation: Division of Gastroenterology, P D Hinduja Hospital, Mumbai, India.
authors.forename: Philip
authors.initials: P
authors.lastname: Abraham
authors.affiliation: Division of Gastroenterology, P D Hinduja Hospital, Mumbai, India.
authors.forename: Anand
authors.initials: A
authors.lastname: Joshi
authors.affiliation: Division of Gastroenterology, P D Hinduja Hospital, Mumbai, India.
authors.forename: Tarun
authors.initials: T
authors.lastname: Gupta
authors.affiliation: Division of GI Surgery, P D Hinduja Hospital, Mumbai, India.
authors.forename: Sudeep
authors.initials: S
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000150:complications / Q000208:ethnology* / Q000473:pathology / Q000601:surgery; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D019366:Western World; D044465:White People; D055815:Young Adult
keywords: Crohn’s disease; India; Montreal classification; natural history