Medicine of the Future in America

Long-term prognosis of early-onset Crohn’s disease: Intestinal resections (Part 2)

Table 4 compares disease location in males and females who did not require an intestinal resection with those who required one or multiple intestinal resections. For both males and females, most early-onset Crohn’s disease with ileocolonic involvement required at least one, and usually multiple intestinal resections, while both males and females with only localized colonic disease were less likely to require an intestinal resection (P<0.05). Table 5 shows the data redistributed using the modern Vienna system. With this schema, the disease is categorized as upper tract in type even if it is also detected in ileum or colon. Even with this modification, for both males and females, most who eventually required an intestinal resection had ileocolonic involvement (P<0.05).

Table 6 compares clinical behaviour of males and females with early-onset Crohn’s disease, defined on the basis of the modern Vienna schema , in patients having no intestinal resection compared with those having one or multiple intestinal resections. More resected patients could be classified as having complex disease with either strictures or penetrating disease complications (P<0.05).

TABLE 4 Disease location with single or multiple resections

Males Females
NR*n (%) ORn (%) MRn (%) NR*n (%) ORn (%) MRn (%)
Ileum 14 (36.8) 11 (32.4) 4 (16.7) 8 (13.3) 5 (15.0) 4 (14.3)
Colon 10 (26.3) 4 (11.8) 0 29 (48.3) 4 (10.0) 0
Ileocolon 13 (34.2) 19 (55.9) 20 (83.3) 22 (36.7) 30 (75.0) 24 (85.7)

*In the nonresected (NR) groups, there were also two patients with early-onset disease (one male, one female) who had isolated upper gastrointestinal tract disease without ileal or colonic involvement. MR Multiple resections; OR One resection

TABLE 5 Disease location using the Vienna classification system and resections

Males Females
NRn (%) R %) ° c MRn (%) NRn (%) R %) ° c MRn (%)
Ileum 13 (34.2) 11 (32.4) 1 (4.2) 7 (11.7) 6 (15.0) 4 (14.3)
Colon 9 (23.7) 3 (8.8) 0 28 (46.7) 4 (10.0) 0
Ileocolon 10 (26.3) 14 (41.2) 14 (58.3) 18 (30.0) 23 (57.5) 17 (60.7)
UGI 6 (15.8) 6 (17.6) 9 (37.5) 7 (11.7) 7 (17.5) 7 (25.0)

MR Multiple resections; NR No resection; OR One resection; UGI Upper gastrointestinal tract involvement regardless of involvement elsewhere

TABLE 6 Disease behaviour and intestinal resection

Males Females
NRn (%) ORn (%) MRn (%) NRn (%) ORn (%) MRn (%)
NSNP 18 (47.4) 2 (5.9) 1 (4.2) 30 (50.0) 5 (12.5) 0
Strict 12 (31.6) 11 (32.4) 5 (20.8) 11 (18.3) 14 (35.0) 11 (39.3)
Penet 8 (21.1) 21 (61.8) 18 (75.0) 19 (31.2) 21 (52.5) 17 (60.7)

MR Multiple resections; NR No resection; NSNP Nonstricturing and nonpenetrating; OR One resection; Penet Penetrating; Strict Stricturing

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This entry was posted in Crohn’s disease and tagged Clinical behaviour of Crohn’s disease, Crohn's disease, Granulomatous colitis, Natural history of Crohn’s disease, Vienna classification.
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