Early development of stricturing or penetrating pattern in Crohn's disease is influenced by disease location, number of flares, and smoking but not by NOD2/CARD15 genotype
[en] Background: Crohn's disease is a heterogeneous entity. Disease behaviour, characterised as structuring, penetrating, or non-stricturing non-penetrating, is a clinically important phenotype as it is associated with complications and need for surgery. It has recently been showed that the behaviour of Crohn's disease changes over the course of the disease. Aim: To assess the association between rapid development of a penetrating or stricturing pattern of Crohn's disease and demographic and clinical characteristics as well as NOD2/CARD15 genotype. Patients and methods: A total of 163 patients with a firm diagnosis of Crohn's disease and who had non-penetrating non-stricturing disease at diagnosis were studied. Various demographic and clinical characteristics as well as anitsaccharomyces cerevisiae antibody status and NOD2/CARD15 genotype were documented in these patients. These characteristics were compared in subgroups of patients according to evolution of disease behaviour five years after diagnosis. Results: Five years after diagnosis there were 110 (67.5%) patients with non-structuring non-penetrating disease, 18 (11%) with stricturing disease, and 35 (21.5%) with penetrating disease. In multivariate analysis, only disease location and number of flares per year were significantly discriminant between the three subgroups (p=0.0009 and 0.0001, respectively). Ileal location of the disease was associated with a stricturing pattern while a high number of flares was associated with a penetrating pattern. Active smoking was also associated with a penetrating pattern compared with a non-stricturing non-penetrating pattern only. Conclusions: Early development of stricturing or penetrating behaviour in Crohn's disease is influenced by disease location, clinical activity of the disease, and smoking habit, but not by NOD2/CARD15 genotype.
Disciplines :
Gastroenterology & hepatology
Author, co-author :
Louis, Edouard ; Université de Liège - ULiège > Département des sciences cliniques > Hépato-gastroentérologie
Michel, V.
Hugot, J. P.
Reenaers, Catherine ; Université de Liège - ULiège > Département des sciences cliniques > Rhumatologie
Fontaine, Fernand
Delforge, M.
El Yafi, F.
Colombel, J. F.
Belaiche, Jacques ; Université de Liège - ULiège > Département des sciences cliniques > Hépato-gastroentérologie
Language :
English
Title :
Early development of stricturing or penetrating pattern in Crohn's disease is influenced by disease location, number of flares, and smoking but not by NOD2/CARD15 genotype
Gower-Rousseau C, Salomez JL, Dupas JL, et al. Incidence of inflammatory bowel disease in Northern France (1988-1990). Gut 1994;35:1433-8.
Jenkins D, Balsitis M, Gallivan S, et al. Guidelines for the initial biopsy diagnosis of suspected chronic idiopathic inflammatory bowel disease. The British Society of Gastroenterology Initiative. J Clin Pathol 1997;50:93-105.
Sutherland LR. Different patterns of Crohn's disease. In: Prantera C, Korelitz B, eds. Crohn's Disease. New York: Marcel Dekker Inc, 1996:201-15.
Hugot JP, Chamaillard M, Zouali H, et al. Association of NOD2 leucin-rich repeat variants with susceptibility to Crohn's disease. Nature 2001;411:599-603.
Ogura Y, Bonen DK, Inohara N, et al. A frameshift mutation in NOD2 associated with susceptibility to Crohn's disease. Nature 2001;411:603-6.
Hampe J, Cuthbert A, Crouche PJP, et al. Association between insertion mutation in NOD2 gene ond Crohn's disease in German and British population. Lancet 2001;357:1925-8.
Lesage S, Zouali H, Cezard JP, et al. CARD15/NOD2 mutational analysis ond genotype-phenotype correlation in 612 patients with inflammatory bowel disease. Am J Hum Genet 2002;70:845-57.
Ahmad T, Armuzzi A, Bunce M, et al. The molecular classification of the manifestations of Crohn's disease. Gastroenterology 2002;122:854-66.
Cuthbert AP, Fisher SA, Mirza MM, et al. The contribution of NOD2 gene mutations to the risk and site of disease in inflammatory bowel disease. Gastroenterology 2002;122:867-74.
Gasche C, Scholmerich J, Brynskov J, et al. A simple classification of Crohn's disease: report of the working party of the world congresses of gastroenterology, Vienna 1998. Inflamm Bowel Dis 2000;6:8-15.
Louis E, Hugot JP, Colombel JF, et al. NOD2/CARD15 mutations in Crohn's disease are associated with young age at diagnosis and ileal location. Gastroenterology 2002;122(suppl):M1405.
Eri RD, Pandeya N, Purdie D, et al. Frequency and association of the 3020INSC insertion in the NOD2 Crohn disease susceptibility gene in a well-characterized patient cohort. Gastroenterology 2002;122(suppl):M1410.
Vermeire S, Esters N, Pierik M, et al. Detailed study on phenotypical associations of NOD2/CARD15 mutations in Crohn's disease. Gastroenterology 2002;122(suppl):M1413.
Louis E, Collard A, Oger AF, et al. Behaviour of Crohn's disease according to the Vienna classification: changing pattern over the course of the disease. Gut 2001;49:777-82.
Abreu MT, Taylor KD, Lin YC, et al. Mutations in NOD2 are associated with fibrostenosing disease in patients with Crohn's disease. Gastroenterology 2002;123:679-88.
Radlmayr M, Török HP, Martin K, et al. The c-insertion mutation of the NOD2 gene is associated with fistulizing and fibrostenotic phenotypes in Crohn's disease. Gastroenterology 2002;122:2091-2.
Hampe J, Grebe J, Nikolaus S, et al. Association of NOD2 (CARD15) genotype with clinical course of Crohn's disease cohort study. Lancet 2002;359:1661-5.
Calkins BM. A meta-analysis of the role of smoking in inflammatory bowel disease. Dig Dis Sci 1989;34:1841-54.
Sutherland LR, Ramcharan S, Bryant H, et al. Effect of cigarette smoking on recurrence of Crohn's disease. Gastroenterology 1990;98:1123-8.
Cosnes J, Carbonnel F, Beaugerie L, et al. Effects of smoking on the long term course of Crohn's disease. Gastroenterology 1996;110:424-31.
Main J, McKenzie H, Yeaman GR, et al. Antibody to Saccharomyces cerevisiae (bakers' yeast) in Crohn's disease. BMJ 1988;297:1105-6.
Sendid B, Colombel JF, Jacquinot PM, et al. Specific antibody response to oligomannosidic epitopes in Crohn's disease. Clin Diagn Lab Immunol 1996;3:219-26.
Quinton JF, Sendid B, Reumaux D, et al. Anti-Sacchoromyces cerevisiae mannan antibodies combined with anti-neutrophil cytoplasmic antibodies in inflammatory bowel disease: prevalence and diagnostic role. Gut 1998;42:788-91.
Vasiliauskas EA, Kam LY, Karp LC, et al. Marker antibody expression stratifies Crohn's disease into immunologically homogeneous subgroups with distinct clinical characteristics. Gut 2000;47:487-96.
Greenstein AJ, Lachman P, Sachar DB, et al. Perforating and non-perforating indications for repeated operations in Crohn's disease: evidence for two clinical forms. Gut 1988;29:588-92.
Sachar DB, Andrews HA, Farmer RG, et al. Proposed classification of patient subgroups in Crohn's disease. Gastroenterol Int 1992;5:141-54.
Greenway SE, Buckmire MA, Marroquin C, et al. Clinical subtypes of Crohn's disease according to surgical outcome. J Gastrointest Surg 1999;3:145-51.
Steinhart AH, Girgrah N, McLeod RS. Reliability of a Crohn's disease clinical classification scheme based on disease behavior. Inflamm Bowel Dis 1998;4:228-34.
Achkar JP, Brzezinski A. Interobserver agreement for disease behaviour phenotype in Crohn's disease. Gastroenterology 2002;122(suppl):W1293.
Lautenbach E, Berlin JA, Lichtenstein GR. Risk factors for early postoperative recurrence of Crohn's disease. Gastroenterology 1998;115:259-67.
Yamamoto T, Allan RN, Keighley MR. Perforating ileocaecal Crohn's disease does not carry a high risk of recurrence but usually re-presents as perforating disease. Dis Colon Rectum 1999;42:519-24.
Peeters M, Nevens H, Baert F, et al. Familial aggregation in Crohn's disease: increased age-adjusted risk and concordance in clinical characteristics. Gastroenterology 1996;111:597-603.
Bayless TM, Tokayer AZ, Polito JM II, et al. Crohn's disease: concordance for site and clinical type in affected family-members-potential hereditary influences. Gastroenterology 1996;111:573-9.
Satsangi J, Grootscholten C, Holt H, et al. Clinical patterns of familial inflammatory bowel disease. Gut 1996;38:738-41.
Farmer RG, Hawk WA, Turnbull RB Jr. Indications for surgery in Crohn's disease. Gastroenterology 1976;71:245-50.
Van Kruiningen HJ, Ganley LM, Freda BJ. The role of Peyer's patches in the age- related incidence of Crohn's disease. J Clin Gastroenterol 1997;24:470-5.
Kelly JK, Preshaw RM. Origin of fistulas in Crohn's disease. J Clin Gastroenterol 1989;11:193-6.
Colombel JF, Grandbastien B, Gower-Rousseau C, et al. Clinical characteristics of Crohn's disease in 72 families. Gastroenterology 1996;111:604-7.