Gastroenterology

Gastroenterology

Volume 130, Issue 3, March 2006, Pages 650-656
Gastroenterology

Clinical–alimentary tract
Predictors of Crohn’s Disease

https://doi.org/10.1053/j.gastro.2005.12.019Get rights and content

Background & Aims: Early intensive therapy in Crohn’s disease should be considered only in patients with disabling disease. The aim of our study was to identify at diagnosis factors predictive of a subsequent 5-year disabling course. Methods: Among the 1526 patients seen at our unit with Crohn’s disease diagnosed between 1985 and 1998, we excluded patients operated on within the first month of the disease, patients with inadequate data, and patients with severe chronic nondigestive disease. In the 1188 remaining patients, Crohn’s disease course within the first 5 years of the disease was categorized as disabling when at least 1 of the criteria of clinical severity, conventionally predefined, was present. Results: Among the 1123 patients with follow-up data allowing full 5-year course classification, the rate of disabling disease was 85.2%. Independent factors present at diagnosis and significantly associated with subsequent 5-year disabling were the initial requirement for steroid use (OR 3.1 [95% CI: 2.2–4.4]), an age below 40 years (OR 2.1 [95% CI: 1.3–3.6]), and the presence of perianal disease (OR 1.8 [95% CI: 1.2–2.8]). The positive predictive value of disabling disease in patients with 2 and 3 predictive factors of disabling disease was 0.91 and 0.93, respectively. These values were 0.84 and 0.91, respectively, when tested prospectively in an independent group of 302 consecutive patients seen at our institution from 1998. Conclusions: At diagnosis of Crohn’s disease in a referral center, factors predictive of subsequent 5-year disabling course are an age below 40 years, the presence of perianal disease, and the initial requirement for steroids.

Section snippets

Patient Selection

We considered for inclusion in the retrospective part of the study all the patients with CD seen consecutively at our unit between January 1985 and January 1998. Diagnosis of CD was based on Lennard-Jones criteria.11 Among the 1526 patients screened, we excluded patients operated on at diagnosis (n = 62), patients with incomplete medical data regarding either the diagnosis period or the time interval between diagnosis and the end of the 5-year study period or loss to follow-up (n = 263), and

Patient Populations

Among the 262 patients managed at our institution from the first flare-up of the disease, 105 (40.0%) were males and 157 (60.0%) were females, with a median age at diagnosis of 27.8 years (range, 12.6–83.2 years). CD initially involved small bowel only, small bowel and colon, and colon alone in 26.0%, 37.8%, and 36.2% of the patients, respectively. Perianal lesions were present at diagnosis in 62 (23.7%) patients. Steroids were required for treating the first flare-up in 170 (64.9%) patients.

Discussion

Our results suggest that most patients with CD seen at referral centers will experience a disabling clinical course in the 5-year period following diagnosis. We identified at diagnosis 3 factors (steroids required for treating the first flare-up, age below 40 years, and presence of perianal disease at diagnosis) independently associated with an increased risk of subsequent 5-year disabling CD clinical course. In our cohort, the presence at diagnosis in an individual patient of 2 or 3 out of the

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