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Phenotype at diagnosis predicts recurrence rates in Crohn's disease

Background & aims: In Crohn's disease (CD), studies associating phenotype at diagnosis and subsequent long-term disease course are important for patient counselling and health care planning.

A prospectively assembled uniformly diagnosed European population-based inception cohort of CD patients was classified according to the Vienna Classification for disease phenotype at diagnosis. Surgical and non-surgical recurrence rates throughout a ten-year follow-up period were calculated. Multivariate analysis was performed to classify risk factors present at diagnosis for recurrent disease.

A total of 358 were classified for phenotype at diagnosis of whom 262 (73.2%) had a first recurrence and 113 patients (31.6%) a first surgical recurrence during the first 10 years after diagnosis. Patients with upper gastrointestinal disease at diagnosis had excess risk of recurrences (Hazard Ratio (HR): 1.54, 95% Confidence Interval (CI): 1.13 - 2.10) whereas age = 40 years at diagnosis was protective (HR: 0.82, 95% CI: 0.70 - 0.97). Colonic disease was a protective characteristic for resective surgery (HR: 0.38, 95% CI: 0.21 - 0.69). More frequent resective surgical recurrences were reported from Copenhagen (HR: 3.23, 95% CI: 1.32 - 7.89).

A mild course of disease in terms of disease recurrence was observed in this European cohort. Phenotype at diagnosis had predictive value for disease recurrence with upper gastro-intestinal disease being the most important positive predictor. A phenotypic North-South gradient in CD may be present illustrated by higher surgery risks in some of the Northern-European centres.

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Dept of Gastroenterology, University Hospital Maastricht
Debyelaan 25
6202 AZ Maastricht
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