E. Louis et al., Behaviour of Crohn's disease according to the Vienna classification: changing pattern over the course of the disease, GUT, 49(6), 2001, pp. 777-782
Background-Crohn's disease is a heterogeneous disorder with both a genetic
and environmental aetiology. Clinical classifications of the disease, such
as the newly proposed Vienna classification, may help to define subgroups o
f patients suitable for studying the influence of specific genetic or envir
onmental factors.
Aim-To assess the stability over the course of the disease of its location
and behaviour, as determined according to the Vienna classification.
Patients and methods-The notes of 297 Crohn's disease patients regularly fo
llowed up at our institution were carefully reviewed retrospectively. The b
ehaviour and location of the disease according to the Vienna classification
were determined at diagnosis and after 1, 3, 5, 10, 15, 20, and 25 years o
f follow up. The proportions of the different behaviours and locations of t
he disease were calculated at these time points. A statistical analysis of
the evolution of these characteristics over 10 years was performed on a sub
group of 125 patients with at least 10 years of follow up. The influence of
age at diagnosis on location and behaviour of the disease was assessed as
well as the influence of location on the behaviour of the disease.
Results-The location of the disease remained relatively stable over the cou
rse of the disease. Although the proportion of patients who had a change in
disease location became statistically significant after five years (p=0.01
), over 10 years only 15.9% of patients had a change in location (p <0.001)
. We observed a more rapid and prominent change in disease behaviour, which
was already statistically significant after one year (p=0.04). Over 10 yea
rs, 45.9% of patients had a change in disease behaviour (p <0.0001). The mo
st prominent change was from non-stricturing non-penetrating disease to eit
her stricturing (27.1%; p <0.0001) or penetrating (29.4%; p <0.0001) diseas
e. Age at diagnosis had no influence on either location or behaviour of dis
ease. Ileal Crohn's disease was more often stricturing, and colonic or ileo
colonic Crohn's disease was more often penetrating: this was already the ca
se at diagnosis and became more prominent after 10 years (p <0.05).
Conclusions-Location of Crohn's disease, as defined by the Vienna classific
ation, is a relatively stable phenotype which seems suitable for phenotype-
genotype analyses. Behaviour of Crohn's disease according to the Vienna cla
ssification varies dramatically over the course of the disease and cannot b
e used in phenotype-genotype analyses. The potential influence of genes on
the behaviour of Crohn's disease should be studied in subgroups of patients
defined by their disease behaviour after a fixed duration of disease.