Crohn's disease in a southern European country: Montreal classification and clinical activity

Authors

  • Fernando Magro MD, PhD,

    Corresponding author
    1. Portuguese Group of Studies of Inflammatory Bowel Diseases, Oporto University, Portugal
    2. Hospital de São João, Oporto University, Portugal
    3. Faculty of Medicine, Oporto University, Portugal
    • Institute of Pharmacology and Therapeutics, Faculdade de Medicina, 4200 Porto, Portugal
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  • Francisco Portela MD,

    1. Portuguese Group of Studies of Inflammatory Bowel Diseases, Oporto University, Portugal
    2. Hospitais da Universidade de Coimbra, Oporto University, Portugal
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  • Paula Lago MD,

    1. Portuguese Group of Studies of Inflammatory Bowel Diseases, Oporto University, Portugal
    2. Hospital Geral de Santo António, Oporto University, Portugal
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  • João Ramos de Deus MD,

    1. Portuguese Group of Studies of Inflammatory Bowel Diseases, Oporto University, Portugal
    2. Hospital Amadora Sintra, Oporto University, Portugal
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  • Ana Vieira MD,

    1. Portuguese Group of Studies of Inflammatory Bowel Diseases, Oporto University, Portugal
    2. Hospital Garcia de Orta, Oporto University, Portugal
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  • Paula Peixe MD,

    1. Portuguese Group of Studies of Inflammatory Bowel Diseases, Oporto University, Portugal
    2. Hospital Egas Moniz, Oporto University, Portugal
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  • Isabelle Cremers MD,

    1. Portuguese Group of Studies of Inflammatory Bowel Diseases, Oporto University, Portugal
    2. Hospital de S. Bernardo Setubal, Oporto University, Portugal
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  • José Cotter MD,

    1. Portuguese Group of Studies of Inflammatory Bowel Diseases, Oporto University, Portugal
    2. Centro Hospitalar do Alto Ave – Guimarães, Oporto University, Portugal
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  • Marília Cravo MD, PhD,

    1. Portuguese Group of Studies of Inflammatory Bowel Diseases, Oporto University, Portugal
    2. Instituto Português Oncologia Francisco Gentil-Lisboa, Oporto University, Portugal
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  • Lourdes Tavares MD,

    1. Portuguese Group of Studies of Inflammatory Bowel Diseases, Oporto University, Portugal
    2. Hospital de Santa Maria-Lisboa, Oporto University, Portugal
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  • Jorge Reis MD,

    1. Portuguese Group of Studies of Inflammatory Bowel Diseases, Oporto University, Portugal
    2. Hospital Pulido Valente-Lisboa, Oporto University, Portugal
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  • Raquel Gonçalves MD,

    1. Portuguese Group of Studies of Inflammatory Bowel Diseases, Oporto University, Portugal
    2. Hospital S Marcos-Braga, Oporto University, Portugal
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  • Horácio Lopes MD,

    1. Portuguese Group of Studies of Inflammatory Bowel Diseases, Oporto University, Portugal
    2. Hospital das Caldas da Raínha, Oporto University, Portugal
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  • Paulo Caldeira MD,

    1. Portuguese Group of Studies of Inflammatory Bowel Diseases, Oporto University, Portugal
    2. Hospital de Faro, Oporto University, Portugal
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  • Paula Ministro MD,

    1. Portuguese Group of Studies of Inflammatory Bowel Diseases, Oporto University, Portugal
    2. Hospital S.Teotónio-Viseu, Oporto University, Portugal
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  • Laura Carvalho MD,

    1. Portuguese Group of Studies of Inflammatory Bowel Diseases, Oporto University, Portugal
    2. Hospital de Vila Real, Oporto University, Portugal
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  • Luis Azevedo MD,

    1. Portuguese Group of Studies of Inflammatory Bowel Diseases, Oporto University, Portugal
    2. Faculty of Medicine, Oporto University, Portugal
    3. Department of Biostatistics and Medical Informatics – Faculty of Medicine, Oporto University, Portugal
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  • Altamiro Da Costa-Pereira MD, PhD

    1. Portuguese Group of Studies of Inflammatory Bowel Diseases, Oporto University, Portugal
    2. Faculty of Medicine, Oporto University, Portugal
    3. Department of Biostatistics and Medical Informatics – Faculty of Medicine, Oporto University, Portugal
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  • GEDII: Amadeu Corte Real Nunes; Ana Isabel Valente; Ana Isabel Vieira; Antónia Duarte; António Marques; Antonio Queiroz; Bernardino Ribeiro; Carolina Duesca; Celeste Fátima Viveiros; Cidalina Caetano; Claudia Sequeira; David Horta; Edgar Gencsi; Estela Monteiro; Fernando Magro; Filipe Gomes Silva; Francisco Portela; Glória Marinho; Helder Cardoso; Helena Vasconcelos; Helena Sousa; Henrique Morna; Horácio Lopes; Isabel Bastos; Isabel Medeiros; Isabel Seves; Isadora Rosa; João Baranda; João Ramos de Deus; Jorge Amil Dias; J Godinho Lopes; João Freitas; J. Pinto de Matos; Jorge Reis; Jorge Vieira; Jose Cotter; José Estevens; J M Ribeiro; Laura Carvalho; Leopoldo Matos; Luís Correia; Luís Jasmins; Luis Lebre; Luísa Barros; Luísa Gloria; Lurdes Tavares; Marília Cravo; Margarida Marques; Marie Isabelle Cremers; Maria do Rosário Maldonado; Manuel Correia; Maria de Lurdes Gonçalves; Mário César; Miguel Areia; Manuela Ferreira; Mário Júlio Campos; Marta Salgado; Nuno Almeida; Paulo Andrade; Paula Lago; Paula Ministro; Paula Moura Santos; Paula Peixe; Paulo Caldeira; Paulo Freire; Pedro Martins; Raquel Gonçalves; Ricardo Ferreira; Ricardo Freire; Rui Loureiro; Rui Sousa; Rute Cerqueira; Salazar Sousa; Salomé Costa Lima; Sara Folgado Alberto; Silvia Leite; Sofia Mendes; Sónia Barroso; Sandra Lopes; Sónia Nobre; Tiago Bana e Costa; Vítor Fernandes.

Abstract

Background: Given the heterogeneous nature of Crohn's disease (CD), our aim was to apply the Montreal Classification to a large cohort of Portuguese patients with CD in order to identify potential predictive regarding the need for medical and/or surgical treatment.

Methods: A cross-sectional study was used based on data from an on-line registry of patients with CD.

Results: Of the 1692 patients with 5 or more years of disease, 747 (44%) were male and 945 (56%) female. On multivariate analysis the A2 group was an independent risk factor of the need for steroids (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.1–2.3) and the A1 and A2 groups for immunosuppressants (OR 2.2; CI 1.2–3.8; OR 1.4; CI 1.0–2.0, respectively). An L3+L34 and L4 location were risk factors for immunosuppression (OR 1.9; CI 1.5–2.4), whereas an L1 location was significantly associated with the need for abdominal surgery (P < 0.001). After 20 years of disease, less than 10% of patients persisted without steroids, immunosuppression, or surgery. The Montreal Classification allowed us to identify different groups of disease severity: A1 were more immunosuppressed without surgery, most of A2 patients were submitted to surgery, and 52% of L1+L14 patients were operated without immunosuppressants.

Conclusions: Stratifying patients according to the Montreal Classification may prove useful in identifying different phenotypes with different therapies and severity. Most of our patients have severe disease.

(Inflamm Bowel Dis 2009)

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