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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Am+J+Gastroenterol
2013 ; 108
(1
): 106-12
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Relationship between proximal Crohn s disease location and disease behavior and
surgery: a cross-sectional study of the IBD Genetics Consortium
#MMPMID23229423
Lazarev M
; Huang C
; Bitton A
; Cho JH
; Duerr RH
; McGovern DP
; Proctor DD
; Regueiro M
; Rioux JD
; Schumm PP
; Taylor KD
; Silverberg MS
; Steinhart AH
; Hutfless S
; Brant SR
Am J Gastroenterol
2013[Jan]; 108
(1
): 106-12
PMID23229423
show ga
OBJECTIVES: In classifying Crohn's disease (CD) location, proximal (L4) disease
includes esophagogastroduodenal (EGD) and jejunal disease. Our aim was to
determine the influence of proximal disease on outcomes of behavior and need for
surgery and to determine if there was significant clinical heterogeneity between
EGD and jejunal disease. METHODS: We performed a cross-sectional query of the
NIDDK (National Institute of Diabetes and Digestive and Kidney Disease)
Inflammatory Bowel Disease Genetics Consortium (IBDGC) database of patients with
a confirmed diagnosis of CD and phenotyped per the IBDGC manual. Presence of any
L4, L4-EGD, L4-jejunal, and non-L4 disease (L1-ileal, L2-colonic, and
L3-ileocolonic) was compared with demographic features including age, race,
ethnicity, smoking and inflammatory bowel disease (IBD) family history, diagnosis
age, disease duration, clinical outcomes of inflammatory, stricturing or
penetrating behavior, and CD abdominal surgeries. Univariate and multivariable
analyses were performed with R. RESULTS: Among 2,105 patients with complete
disease location data, 346 had L4 disease (175 L4-EGD, 115 L4-jejunal, and 56 EGD
and jejunal) with 321 having concurrent L1-L3 disease. In all, 1,759 had only
L1-L3 disease. L4 vs. non-L4 patients were more likely (P<0.001) to be younger at
diagnosis, non-smokers, have coexisting ileal involvement, and have stricturing
disease. L4-jejunal vs. L4-EGD patients were at least twice as likely (P<0.001)
to have had ileal disease, stricturing behavior, and any or multiple abdominal
surgeries. Remarkably, L4-jejunal patients had more (P<0.001) stricturing
behavior and multiple abdominal surgeries than non-L4 ileal disease patients.
Logistic regression showed stricturing risks were ileal (without proximal) site
(odds ratio (OR) 3.18; 95% confidence interval 2.23-4.64), longer disease
duration (OR 1.33/decade; 1.19-1.49), jejunal site (OR 2.90; 1.89-4.45), and
older age at diagnosis (OR 1.21/decade; 1.10-1.34). Multiple surgery risks were
disease duration (OR 3.74/decade; 3.05-4.64), penetrating disease (OR 2.60;
1.64-4.21), and jejunal site (OR 2.39; 1.36-4.20), with short duration from
diagnosis to first surgery protective (OR 0.87/decade to first surgery;
0.84-0.90). CONCLUSIONS: Jejunal disease is a significantly greater risk factor
for stricturing disease and multiple abdominal surgeries than either EGD or ileal
(without proximal) disease. The Montreal site classification should be revised to
include separate designations for jejunal and EGD disease.