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Outcome of Patients with Nonstenotic, Nonfistulizing Crohn’s Disease

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Abstract

The nonstenotic, nonfistulizing (or inflammatory) pattern of Crohn’s disease appears to be unstable in time and may evolve toward either the stenotic or the fistulizing pattern. We aimed to assess the course of the inflammatory disease and its relation to certain clinical characteristics. After a mean follow-up of 93 months, we evaluated 73 patients with an inflammatory pattern. The behavior trend and its relation to disease location, initial treatment, and need for corticosteroids, immunosuppressors, and surgical resection were analyzed. In 64% of the patients the inflammatory pattern did not change, while in 14 and 22% it evolved toward a stenotic and a fistulizing pattern, respectively. This change was mainly determined by the appearance of perianal disease (75%). The mean time to behavior evolution was 67 months. Most patients required corticosteroids (92%). Need for immunosuppressors (48%) and surgical resection (30%) was significantly greater (P&<0.05) among patients with a change in pattern than in those with persistent inflammatory disease. The inflammatory pattern of CD remains stable in about half of patients. The course of this pattern is not indolent, however, since the needs for immunosuppression and surgical resection during follow-up are considerable.

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References

  1. De Dombal FT, Burton I, Goligher C: The early and late results of surgical treatment for Crohn’s disease. Br J Surg 11:805–816, 1971

    Article  Google Scholar 

  2. Greenstein AJ, Lachman P, Sachar DB, et al.: Perforating and non-perforating indications for repeated operations in Crohn’s disease: Evidence for two clinical forms. Gut 29:588–592, 1988

    Article  CAS  Google Scholar 

  3. Aeberhard P, Berchtold W, Riedtmann HJ, et al.: Surgical recurrence of perforating and nonperforating Crohn’s disease. Dis Colon Rectum 39:80–87, 1996

    Article  CAS  Google Scholar 

  4. Gasche C, Scholmerich J, Brynskov J, et al.: A simple classification of Crohn’s disease: Report of the working party for the world congresses of gastroenterology, Vienna 1998. Inflamm Bowel Dis 6:8–15, 2000

    Article  CAS  Google Scholar 

  5. Sachar DB, Andrews HA, Farmer RG, et al.: Proposed classification of patient subgroups in Crohn’s disease. Gastroenterol Int 5:141–154, 1992

    Google Scholar 

  6. Louis E, Collard A, Oger AF, et al.: Behaviour of Crohn’s disease according to the Vienna classification: changing pattern over the course of the disease. Gut 49:777–782, 2001

    Article  CAS  Google Scholar 

  7. Lennard-Jones JE: Classification of inflammatory bowel disease. Scand J Gastroenterol Hepatol 170:2–6, 1989

    Article  CAS  Google Scholar 

  8. Loftus EV, Schoenfeld P, Sandborn WJ: The epidemiology and natural history of Crohn’s disease in population-based patient cohorts from North America: a systematic review. Aliment Pharmacol Ther 16:51–60, 2002

    Article  Google Scholar 

  9. Tavarela F, Tomá J, Barros L, et al.: Clinical outcome of Crohn’s disease: Analysis according to the Vienna classification and clinical activity. Inflamm Bowel Dis 7:306–313, 2001

    Article  Google Scholar 

  10. Lichtenstein GR: Treatment of fistulizing Crohn’s disease. Gastroenterology 119:1132–1147, 2000

    Article  CAS  Google Scholar 

  11. Hanauer SB, Sandborn W: Management of Crohn’s disease in adults. Am J Gastroenterol 96(3):635–643, 2001

    Article  CAS  Google Scholar 

  12. Hinojosa J, Nos P, Ramírez JJ, et al.: Evolutive pattern in Crohn’s disease. A simplified index using clinical parameters predicts obstructive behaviour. Eur J Gastroenterol Hepatol 13:1–5, 2001

    Article  Google Scholar 

  13. Nos P, Hinojosa J, Mora J, et al.: Validation of a simplified clinical index to predict evolving patterns in Crohn’s disease. Eur J Gastroenterol Hepatol 14:847–851, 2002

    Article  Google Scholar 

  14. Vasiliauskas EA, Kam LY, Karp LC, et al.: Marker antibody expression stratifies Crohn’s disease with distinct clinical characteristics. Gut 47:1497–1496, 2000

    Article  Google Scholar 

  15. Sans M, Tassies D, Pellise M, et al.: The 4G/4G genotype of the 4G/5G polymorphism of the type-1 plasminogen activator inhibitor (PAI-1) gene is a determinant of penetrating behaviour in patients with Crohn’s disease. Aliment Pharmacol Ther 17:1039–1047, 2003

    Article  CAS  Google Scholar 

  16. Cosnes J, Cattan S, Blain A, et al.: Long-term evolution of disease behavior of Crohn’s disease. Inflamm Bowel Dis 8:244–250, 2002

    Article  Google Scholar 

  17. Steinhart AH, Girgrah N, McLeod RS: Reliability of a Crohn’s disease clinical classification scheme based on disease behavior. Inflamm Bowel Dis 4:228–234, 1998

    Article  CAS  Google Scholar 

  18. Pearson DC, May GR, Fick G, et al.: Azathioprine for maintaining remission of Crohn’s disease. Cochrane Database Syst Rev 2:CD000067, 2000

    Google Scholar 

  19. Sandborn WJ: Azathioprine: State of the art in inflammatory bowel disease. Scand J Gastroenterol 225(Suppl):92–99, 1998

    Article  CAS  Google Scholar 

  20. Lamers CB, Griffioen G, Van Hogezand RA, et al.: Azathioprine: An update on clinical efficacy and safety in inflammatory bowel disease. Scand J Gastroenterol 230(Suppl):111–115, 1999

    CAS  Google Scholar 

  21. Nielsen OH, Vainer B, Rask-Madsen J: Review article: the treatment of inflammatory bowel disease with 6-mercaptopurine or azathioprine. Aliment Pharmacol Ther 15:1699–1708, 2001

    Article  CAS  Google Scholar 

  22. Schwartz DA, Pemberton JH, Sandborn WJ: Diagnosis and treatment of perianal fistulas in Crohn’s disease. Ann Intern Med 135:906–918, 2001

    Article  CAS  Google Scholar 

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Correspondence to Pilar Nos.

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Nos, P., Garrigues, V., Bastida, G. et al. Outcome of Patients with Nonstenotic, Nonfistulizing Crohn’s Disease. Dig Dis Sci 49, 1771–1776 (2004). https://doi.org/10.1007/s10620-004-9568-1

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  • DOI: https://doi.org/10.1007/s10620-004-9568-1

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