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Digestive Diseases and Sciences

, Volume 63, Issue 6, pp 1592–1599 | Cite as

Colonic Crohn’s Disease Is Associated with Less Aggressive Disease Course Than Ileal or Ileocolonic Disease

  • Umang Arora
  • Saurabh Kedia
  • Prerna Garg
  • Sawan Bopanna
  • Saransh Jain
  • Dawesh P. Yadav
  • Sandeep Goyal
  • Vipin Gupta
  • Peush Sahni
  • Sujoy Pal
  • Nihar Ranjan Dash
  • Kumble Seetharama Madhusudhan
  • Raju Sharma
  • Govind Makharia
  • Vineet Ahuja
Original Article

Abstract

Background

The literature on disease characteristics of colonic Crohn’s disease (CD) is sparse, especially from Asia, where the burden of inflammatory bowel disease is on the rise. The present study aims to describe the disease characteristics of colonic CD, and compare it with that of ileal/ileocolonic disease.

Methods

This retrospective study included adult patients of CD (diagnosed by standard criteria, follow-up duration > 6 months) on follow-up between August 2004 and January 2016. The disease location was classified by Montreal classification. The data were recorded on demographic characteristics, smoking status, disease phenotype, disease course, treatment received, hospitalization and surgeries.

Results

Of 406 CD patients, 123 had colonic [mean age (at onset) 30.4 ± 13.2 years, 59.3% males] and 265 had ileal/ileocolonic disease [mean age (at onset) 32.9 ± 13.8 years, 61.5% males] while 18 patients had isolated upper GI disease. The frequency of inflammatory behavior (B1 phenotype; 61.8 vs. 46.4%, p = 0.003), perianal disease (23.6 vs. 4.5%, p < 0.001), and extra-intestinal manifestation (42.3 vs. 30.2%, p = 0.019) was higher in colonic than ileal/ileocolonic CD. Though not statistically significant, requirement of atleast one course of steroid was lower in colonic CD (72.7 vs. 84.2%, p = 0.098). Although there was no difference in the frequency of hospitalization (30.1 vs. 27.1%, p = 0.45), the overall requirement for surgery was significantly lower in colonic CD (17.1 vs. 26.1%, p = 0.032) and patients with colonic disease had a lower cumulative probability of first surgery in the first 10 years of follow-up [Hazard ratio 0.556 (95% CI 0.313–0.985), p = 0.045].

Conclusion

Colonic CD was associated with less aggressive disease behavior and lower requirement of surgery as compared to ileal/ileocolonic CD.

Keywords

Crohn’s disease Surgery Steroids Hospitalization 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Bargen J, Weber H. Regional migratory chronic ulcerative colitis. Surg Gynecol Obstet. 1930;1:964–972.Google Scholar
  2. 2.
    Wells C. Ulcerative colitis and Crohn’s disease. Ann R Coll Surg Engl. 1952;11:105–120.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Lockhart-Mummery HE, Morson BC. Crohn’s disease (regional enteritis) of the large intestine and its distinction from ulcerative colitis. Gut. 1960;1:87–105.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Satsangi J, Silverberg MS, Vermeire S, Colombel J. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut. 2006;55:749–753.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Price AB. Overlap in the spectrum of non-specific inflammatory bowel disease–’colitis indeterminate’. J Clin Pathol. 1978;31:567–577.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Parkes M, Vermeire S, Rioux JD, et al. International Inflammatory Bowel Disease Genetics Consortium. Inherited determinants of Crohn’s disease and ulcerative colitis phenotypes: a genetic association study. Lancet Lond Engl. 2016;387:156–167.CrossRefGoogle Scholar
  7. 7.
    Hancock L, Beckly J, Geremia A, et al. Clinical and molecular characteristics of isolated colonic Crohn’s disease. Inflamm Bowel Dis. 2008;14:1667–1677.CrossRefPubMedGoogle Scholar
  8. 8.
    Ahuja V, Tandon RK. Inflammatory bowel disease: the Indian augury. Indian J Gastroenterol. 2012;31:294–296.CrossRefPubMedGoogle Scholar
  9. 9.
    Singh P, Ananthakrishnan A, Ahuja V. Pivot to Asia: inflammatory bowel disease burden. Intest Res. 2017;15:138–141.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Pugazhendhi S, Amte A, Balamurugan R, Subramanian V, Ramakrishna BS. Common NOD2 mutations are absent in patients with Crohn’s disease in India. Indian J Gastroenterol. 2008;27:201–203.PubMedGoogle Scholar
  11. 11.
    Mahurkar S, Banerjee R, Rani VS, et al. Common variants in NOD2 and IL23R are not associated with inflammatory bowel disease in Indians. J Gastroenterol Hepatol. 2011;26:694–699.CrossRefPubMedGoogle Scholar
  12. 12.
    Arora U, Ananthakrishnan AN, Kedia S, et al. Effect of oral tobacco use and smoking on outcomes of Crohn’s disease in India. J Gastroenterol Hepatol. 2017;33:134–140.CrossRefGoogle Scholar
  13. 13.
    Van Assche G, Dignass A, Panes J, et al. European Crohn’s and Colitis Organisation (ECCO). The second European evidence-based Consensus on the diagnosis and management of Crohn’s disease: Definitions and diagnosis. J Crohns Colitis. 2010;4:7–27.CrossRefPubMedGoogle Scholar
  14. 14.
    Pratap Mouli V, Munot K, Ananthakrishnan A, et al. Endoscopic and clinical responses to anti-tubercular therapy can differentiate intestinal tuberculosis from Crohn’s disease. Aliment Pharmacol Ther. 2017;45:27–36.CrossRefPubMedGoogle Scholar
  15. 15.
    Solberg IC, Vatn MH, Høie O, et al. IBSEN Study Group. Clinical course in Crohn’s disease: results of a Norwegian population-based ten-year follow-up study. Clin Gastroenterol Hepatol. 2007;5:1430–1438.CrossRefPubMedGoogle Scholar
  16. 16.
    Zheng JJ, Cu XQ, Shi XH, et al. Colonoscopic and histologic features of colonic Crohn’s disease in Chinese patients. J Dig Dis. 2007;8:35–41.CrossRefPubMedGoogle Scholar
  17. 17.
    Das K, Ghoshal UC, Dhali GK, Benjamin J, Ahuja V, Makharia GK. Crohn’s disease in India: a multicenter study from a country where tuberculosis is endemic. Dig Dis Sci. 2009;54:1099–1107.CrossRefPubMedGoogle Scholar
  18. 18.
    Makharia GK, Ramakrishna BS, Abraham P, et al. Indian Society of Gastroenterology Task Force on Inflammatory Bowel Disease. Survey of inflammatory bowel diseases in India. Indian J Gastroenterol. 2012;31:299–306.CrossRefPubMedGoogle Scholar
  19. 19.
    Kalaria R, Desai D, Abraham P, Joshi A, Gupta T, Shah S. Temporal change in phenotypic behaviour in patients with Crohn’s disease: Do Indian patients behave differently from western and other Asian patients? J Crohns Colitis. 2016;10:255–261.CrossRefPubMedGoogle Scholar
  20. 20.
    Ng SC, Tang W, Ching JY, et al. Asia-Pacific Crohn’s and Colitis Epidemiologic Study (ACCESS) Study Group. Incidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific Crohn’s and colitis epidemiology study. Gastroenterology. 2013;145:158–165.e2.PubMedGoogle Scholar
  21. 21.
    Cleynen I, González JR, Figueroa C, et al. Genetic factors conferring an increased susceptibility to develop Crohn’s disease also influence disease phenotype: results from the IBDchip European Project. Gut. 2013;62:1556–1565.CrossRefPubMedGoogle Scholar
  22. 22.
    Kyle J. Crohn’s disease in the northeastern and northern Isles of Scotland: an epidemiological review. Gastroenterology. 1992;103:392–399.CrossRefPubMedGoogle Scholar
  23. 23.
    To N, Gracie DJ, Ford AC. Systematic review with meta-analysis: the adverse effects of tobacco smoking on the natural history of Crohn’s disease. Aliment Pharmacol Ther. 2016;43:549–561.CrossRefPubMedGoogle Scholar
  24. 24.
    Cosnes J, Nion-Larmurier I, Afchain P, Beaugerie L, Gendre J-P. Gender differences in the response of colitis to smoking. Clin Gastroenterol Hepatol. 2004;2:41–48.CrossRefPubMedGoogle Scholar
  25. 25.
    Economou M, Trikalinos TA, Loizou KT, Tsianos EV, Ioannidis JPA. Differential effects of NOD2 variants on Crohn’s disease risk and phenotype in diverse populations: a metaanalysis. Am J Gastroenterol. 2004;99:2393–2404.CrossRefPubMedGoogle Scholar
  26. 26.
    Ahmad T, Marshall S-E, Jewell D. Genetics of inflammatory bowel disease: the role of the HLA complex. World J Gastroenterol. 2006;12:3628–3635.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Baumgart M, Dogan B, Rishniw M, et al. Culture independent analysis of ileal mucosa reveals a selective increase in invasive Escherichia coli of novel phylogeny relative to depletion of Clostridiales in Crohn’s disease involving the ileum. ISME J. 2007;1:403–418.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Umang Arora
    • 1
  • Saurabh Kedia
    • 1
  • Prerna Garg
    • 1
  • Sawan Bopanna
    • 1
  • Saransh Jain
    • 1
  • Dawesh P. Yadav
    • 1
  • Sandeep Goyal
    • 1
  • Vipin Gupta
    • 1
  • Peush Sahni
    • 2
  • Sujoy Pal
    • 2
  • Nihar Ranjan Dash
    • 2
  • Kumble Seetharama Madhusudhan
    • 3
  • Raju Sharma
    • 3
  • Govind Makharia
    • 1
  • Vineet Ahuja
    • 1
  1. 1.Department of GastroenterologyAll India Institute of Medical SciencesNew DelhiIndia
  2. 2.Department of GI SurgeryAll India Institute of Medical SciencesNew DelhiIndia
  3. 3.Department of RadiologyAll India Institute of Medical SciencesNew DelhiIndia

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