The Montreal classification for Crohn's disease: clinical application to a Brazilian single-center cohort of 90 consecutive patients

Abstract

CONTEXT: Crohn's disease presents very heterogeneous features from a clinical point of view, and classifying Crohn's disease patients in homogeneous subgroups in the light of genetic, molecular and clinical aspects is challenging. The Montreal Classification for Crohn's disease was proposed in 2005 as an effort to characterize Crohn's disease patients according to recent clinical and research advances in the field of inflammatory bowel disease. Since its proposition, the Montreal Classification needs an ample validation and application among different populations around the world. To date, there are no known studies applying the Montreal Classification to a Brazilian cohort of Crohn's disease patients. OBJECTIVES: To apply the Montreal Classification to a Brazilian cohort of Crohn's disease patients at a referral center for inflammatory bowel disease in Northwestern São Paulo State, Brazil. METHODS: We selected 90 consecutive well-characterized Crohn's disease patients assisted at Inflammatory Bowel Disease Outpatient Clinic between January 1992 and January 2007, with a minimum follow-up of 2 years; data concerning demographic characteristics, clinical onset of disease, age at diagnosis, time of disease, location and behavior of disease, presence of extraintestinal manifestations, familial occurrence, perianal involvement, treatment with biological drugs, and history of surgical treatment were evaluated. RESULTS: Male patients were predominant (54%), with a mean age at diagnosis of 33 ± 14 years old, and a median followup of 5.5 years. Most of the patients were diagnosed between 17 and 40 years old (59%), and had disease located in terminal ileum 46%), with a nonstricturing, nonpenetrating behavior (71%). Time of disease was correlated with necessity of biological treatment, disease behavior, and surgical treatment (P<0.05). CONCLUSIONS: These study findings are consistent with results from other studies conducted among different populations, although a further multicentric study with a larger number of patients would be necessary to validate the Montreal Classification among Brazilian population.

Epidemiological Profile and Clinical Characteristics of Inflammatory Bowel Diseases in a Brazilian Referral Center

“…In this study, IBD was found in all ages, but it was most often found between 20 and 25 years of age. These data are similar to those of previously published studies that highlight the age between 15 and 40 years for the occurence of IBD (24)(25)(26)28) . When assessing the age at diagnosis of patients with IBD separately, CD presents only one peak in the age group, unlike the UC, where a second peak is observed between 40 and 44 years of age (28) .…”

“…All of these studies were retrospective, with variations in the severity of the patients included, as well as the location of data collection, its scope, type of database used, and form of access to the health system, whether public or private. Although these studies are not comparable owning to their different methodologies, there was a variation in the incidence rate of CD from 3.50 to 6.14/100,000 inhabitants and UC from 2.40 to 7.16/100,000 inhabitants, which demonstrates a chronological increase in the incidence of IBD (9,20,21,24,26) .…”

“…In addition to the data on the incidence and prevalence of CD and UC, other factors that contribute to this are the lack of patients' records in the private service and the fact that reporting IBD is not mandatory (10) . Five Brazilian studies that focused on IBD have been published, three in the São Paulo state (9,20,26) , one in the Piaui state (24) , and another in the Espirito Santo state (21) , covering the period from 1986 to 2015. All of these studies were retrospective, with variations in the severity of the patients included, as well as the location of data collection, its scope, type of database used, and form of access to the health system, whether public or private.…”

Mycobacterium avium ssp. paratuberculosis vs Crohn’s Disease

“…50% of patients underwent surgical procedures and 63% were hospitalized at least once. The authors conclude that the profile of CD in evaluated patients was similar to that described in the literature, and these data were corroborated by other Brazilian authors (Faria et al, 2004;Santana et al, 2008;Torres et al, 2010).…”

Perfil Clínico-Epidemiológico De Pacientes Com Doença Inflamatória Intestinal Internados No Hospital Universitário Da Universidade Federal Do Piauí.

“…Em relação ao comportamento da DC, segundo a classificação de Montreal, nosso estudo mostrou que o comportamento não penetrante e não estenosante foi o mais comum. Tal achado foi também observado em estudo realizado São José do Rio Preto (São Paulo, Brasil), que constatou frequência de 71% de comportamento não penetrante e não estenosante em um grupo de 90 pacientes com DC (11) . É importante ressaltar, todavia, que o comportamento da DC varia ao longo do tempo e assim, quanto maior o tempo de doença, maior a proporção de comportamento estenosante ou penetrante.…”