Skip to main content
SpringerLink
Log in

Clinical subtypes of Crohn’s disease according to surgical outcome

  • Published:
Journal of Gastrointestinal Surgery

Abstract

Patients with Crohn’s disease are typically classified into perforator or nonperforator groups. The perforator group includes those who present with acute perforation, fistulas, or abscess formation. The non-perforator group presents with stricture, obstruction, or unresponsiveness to medical therapy. Our purpose was to investigate whether perianal disease constitutes a separate predictor of surgical outcome. The form of presentation was classified as perforator, nonperforator, or perianal disease in 91 patients undergoing 232 operations for Crohn’s disease. Those with perforating complications presented with the highest Crohn’s Disease Activity Index, followed by those with nonperforating complications, and then the perianal disease group. However, the perianal disease group appeared to have the most rapid rate of recurrence and subsequent surgery, followed next by the perforator, and then the nonperforator group. Recurrence rate and subsequent operation intervals for the perforator group appeared to lengthen when those patients were treated with steroids and/or immunosuppressants, as compared to nonsteroidal and/or antimicrobial agents. Recurrence rate and subsequent operation intervals appeared to lengthen for the nonperforator and perianal disease groups when they were treated with nonsteroidal and/or antimicro-bial therapy, as compared to steroids and/or immunosuppressants. Our data indicate that perianal disease, as a form of presentation of Crohn’s disease, has independent predictive value, although this is not accurately reflected by the Crohn’s Disease Activity Index.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Peña AS, Meuwissen SGM. Evidence for clinical subgroups in inflammatory bowel disease. In Targan SR, Shanahan F, eds. Inflammatory Bowel Disease From Bench to Bedside. Philadelphia: Williams & Williams, 1988.

    Google Scholar 

  2. Gilberts EC, Greenstein AJ, Kastei P, Harpaz N, Greenstein RJ. Molecular evidence for two forms of Crohns disease. Proc Natl Acad Sci USA 1994;91:12721–12724.

    Article  PubMed  CAS  Google Scholar 

  3. Greenstein AJ, Sachar DB, Pastemack BS, Janowitz HD. Reoperation and recurrence in Crohn’s colitis and ileocolitis. N Engl J Med 1975;293:685–690.

    Article  PubMed  CAS  Google Scholar 

  4. Sachar DB, Wolfson DM, Greenstein AJ, Goldberg J, Styczynski R, Janowitz HD. Risk factors for postoperative recurrence of Crohn’s disease. Gastroenterology 1983;85:917–921.

    PubMed  CAS  Google Scholar 

  5. Aberhard P, Berchtold W, Reidtman HJ, Stadlemann G. Surgical recurrence of perforating and non-perforating Crohn’s disease. Dis Colon Rectum 1996;39:80–87.

    Article  Google Scholar 

  6. Greenstein AJ. The surgery of Crohn’s disease. Surg Clin North Am 1987;67:573–596.

    PubMed  CAS  Google Scholar 

  7. Sachar DB. The problem of postoperative recurrence of Crohn’s disease. Med Clin North Am 1990;74:183–188.

    PubMed  CAS  Google Scholar 

  8. Perri F, Annese V, Napolitano G, Caruso N, Clemente R, Villani MR, Andrinelli A. Subgroups of patients with Crohn’s disease have different clinical outcomes. Inflamm Bowel Dis 1996;2:1–5.

    Article  Google Scholar 

  9. Farmer RG. Clinical features, laboratory findings, and cause of Crohn’s disease. In Kirsner JB, Shorter RG, eds. Inflammatory Bowel Disease, 4th ed. Philadelphia: Lea & Febiger, 1988.

    Google Scholar 

  10. Farmer RG. Inflammatory bowel disease. In Achkar E, Farmer RG, Fleshier B, eds. Clinical Gastroenterology. Philadelphia: Lea & Febiger, 1992, pp 343–350.

    Google Scholar 

  11. Spiro HM. Crohn’s colitis (granulomatous colitis). In Spiro HM, ed. Clinical Gastroenterology. New York: McGraw-Hill, 1993.

    Google Scholar 

  12. Makowiec F, Jehle EC, Starlinger M. Clinical course of perianal fistulae in Crohn’s disease. Gut 1995;37:696–70l.

    PubMed  CAS  Google Scholar 

  13. Farmer RG, Whelan G, Fazio VW. Long-term follow-up of patients with Crohn’s disease. Gastroenterology 1985;88:1818–1825.

    PubMed  CAS  Google Scholar 

  14. Irvine JE. Usual therapy improves perianal Crohn’s disease as measured by a new disease activity index. Clin Gastroenterol 1995;20:27–32.

    Article  CAS  Google Scholar 

  15. Allan A, Linares L, Spooner HA, Williams JA. Clinical index to quantitate symptoms of perianal Crohn’s disease. Dis Colon Rectum 1992;35:656–661.

    Article  PubMed  CAS  Google Scholar 

  16. Hughes LE. Clinical classification of perianal Crohn’s disease. Dis Colon Rectum 1992;35:928–932.

    Article  PubMed  CAS  Google Scholar 

  17. Whelan G, Farmer RG, Fazio VW, Goormastic M. Recurrence after surgery in Crohn’s disease. Gastroenterology 1985;88:1826–1833.

    PubMed  CAS  Google Scholar 

  18. Greenstein AJ, Lachman P, Sachar DB, Springhorn J, Heimann T, Janowitz, HD, Aufses AH Jr.. Perforating and nonperforating indications for repeated operation in Crohn’s disease: Evidence for two clinical forms. Gut 1988;29:588–592.

    PubMed  CAS  Google Scholar 

  19. Stenson WE, MacDermot RP. Inflammatory bowel disease. In Yamada T, Alpers DH, Owyang C, Powell DW, Silverstein FE, eds. Textbook of Gastroenterology, vol 2. Philadelphia: JB Lippincott, 1995, pp 1757–1758.

    Google Scholar 

  20. Greenstein AJ, Mann D, Sachar DB, Aufees AH Jr.. Free perforation in Crohn’s disease: I. A survey of 99 cases. Am J Gastroenterol 1985;80:682–689.

    PubMed  CAS  Google Scholar 

  21. Meyers S, Sachar DB. Medical therapy of Crohn’s disease. In Kirsner JB, Shorter RG, eds. Inflammatory Bowel Disease. Philadelphia: Lea & Febiger, 1988.

    Google Scholar 

  22. Van Hess P, Van Lier HJJ, Van Eiteren PH, Driessen WMM, Van Hogezad RA, Ten Velde GPM, Bakker JH, Van Tongeren JHM. Effect of sulfasalizine in patients with active Crohn’s disease: A controlled double-blind study. Gut 1981;22:404- colitis.

    Google Scholar 

  23. Summers RW, Switz DM, Sessions JT, Becktel JM, Best WR, Kern F Jr, Singleton JW. National Cooperative Crohn’s Disease Study: Results of drug treatment. Gastroenterology 1979;77:847–869.

    PubMed  CAS  Google Scholar 

  24. Malchow H, Ewe K, Brandes JW, Goebell H, Ehms H, Sommer H, Jesdinsky H. European Cooperative Crohn’s Disease Study (ECCDS): Results of drug treatment. Gastroenterology 1984;86:249–266.

    PubMed  CAS  Google Scholar 

  25. Singleton JW, Summers RW, Kern F, Becktel JM, Best WR, Hansen RN, Winship DH. A trial of sulfasalizine as adjunctive therapy in Crohn’s disease. Gastroenterology 1979;77:887–897.

    PubMed  CAS  Google Scholar 

  26. Kjeldsen J, Schaffalitzky De Muckadell OB. Assessment of disease severity and activity in inflammatory bowel disease. Scand J Gastroenterol 1993;28:l-9.

    Google Scholar 

  27. Singleton JW. Clinical activity assessment in inflammatory bowel disease. Dig Dis Sci 1987;32:42s-45s.

    Article  PubMed  CAS  Google Scholar 

  28. Greenstein AJ, Lachman P, Sachar DB, Heimann T, Spring-horn J, Aufses AH Jr.. Concordance of surgical indications from initial to subsequent operations far Crohn’s disease. Gastroenterology 1986;90(part 2):1438.

    Google Scholar 

  29. Best WR, Becktel JM, Singleton JW, Kern F Jr.. Development of a Crohn’s disease activity index. Gastroenterology 1976; 70:439–444.

    PubMed  CAS  Google Scholar 

  30. Brynskov J, Freund L, Rasmussen SN, Lauritsen K, Schaffalitzky de Muckadell O, William N, Macdonald AS, Tanton R, Molina F, Campanini MC, Bianchi P, Ranzi T, Quarto Di Palo F, Malchow-Moller A, Thomsen OØ, Tage-Jensen U, Binder V, Riis P. A placebo-controlled double-blind randomized trial of cyclosporine therapy in active chronic disease. N Engl J Med 1987;321:845–850.

    Article  Google Scholar 

  31. Present DH, Korelitz BI, Wisch N, Glass JL, Sachar DB, Pastemack BS. Treatment of disease with 6-MP; A long-term randomized double-blind study. N Engl J Med 1980;302:981–1825.

    Article  PubMed  CAS  Google Scholar 

  32. Brandt LJ, Bernstein LH, Boley SJ, Frank MS. Metronidazole therapy for perineal disease: A follow-up study. Gastroenterology 1982;83:383–387.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, MCP • Hahnemann School of Medicine, and the Philadelphia Veterans Administration Medical Center, Philadelphia, Pa.

    Scott E. Greenway M.D., Michael A. Buckmire M.D., Carlos Marroquin M.D., Lora Jadon B.S. & Rolando H. Rolandelli M.D., F.A.C.S.

Authors
  1. Scott E. Greenway M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael A. Buckmire M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carlos Marroquin M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lora Jadon B.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rolando H. Rolandelli M.D., F.A.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Supported by a Veterans Administration Merit Review Grant (R.H.R.), Philadelphia, Pa.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Greenway, S.E., Buckmire, M.A., Marroquin, C. et al. Clinical subtypes of Crohn’s disease according to surgical outcome. J Gastrointest Surg 3, 145–151 (1999). https://doi.org/10.1016/S1091-255X(99)80024-9

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1016/S1091-255X(99)80024-9

Key words

Search

Navigation