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Proximal Crohn's disease location associated with disease behavior and surgery

This month's American Journal of Gastroenterology examines the relationship between proximal Crohn's disease location and disease behavior and surgery.

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In classifying Crohn's disease location, proximal disease includes esophagogastroduodenal and jejunal disease.

Dr Mark Lazarev from Maryland, USA determined the influence of proximal disease on outcomes of behavior and need for surgery.

In addition, the team determined if there was significant clinical heterogeneity between esophagogastroduodenal and jejunal disease.

The team of doctors performed a cross-sectional query of the NIDDK Inflammatory Bowel Disease Genetics Consortium database of patients with a confirmed diagnosis of Crohn's disease and phenotyped per the Inflammatory Bowel Disease Genetics Consortium  manual.

Presence of any location, proximal location, proximal-esophagogastroduodenal, L4-jejunal, and non-location, proximal disease was compared with demographic features including age, race, ethnicity, smoking and inflammatory bowel disease  family history, diagnosis age, disease duration, clinical outcomes of inflammatory, stricturing or penetrating behavior, and Crohn's disease abdominal surgeries.

Among 2,105 patients with complete disease location data, 346 had location, proximal disease with 321 having concurrent L1-L3 disease.

Stricturing risks were ileal site, longer disease duration
American Journal of Gastroenterology

In all, 1,759 had only L1-L3 disease.

The doctors noted that proximal patients were more likely to be younger at diagnosis, non-smokers, have coexisting ileal involvement, and have stricturing disease.

The team noted that proximal-esophagogastroduodenal patients were at least twice as likely to have had ileal disease, stricturing behavior, and any or multiple abdominal surgeries.

The research team noted that proximal-jejunal patients had more stricturing behavior and multiple abdominal surgeries than non-location, proximal ileal disease patients.

The researchers showed that stricturing risks were ileal site, longer disease duration, jejunal site, and older age at diagnosis.

Multiple surgery risks were disease duration, penetrating disease, and jejunal site, with short duration from diagnosis to first surgery protective.

Dr Lazarev's team commented, "Jejunal disease is a significantly greater risk factor for stricturing disease and multiple abdominal surgeries than either esophagogastroduodenal or ileal disease."

"The Montreal site classification should be revised to include separate designations for jejunal and esophagogastroduodenal disease."

Am J Gastroenterol 2013; 108:106112
21 January 2013

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