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A rolling phenotype in Crohn's disease.

James Irwin1,2,3, Emma Ferguson1,3, Lisa A Simms1

  • 1Inflammatory Bowel Diseases Research Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia.

Plos One
|April 7, 2017
PubMed
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The rolling phenotype model for Crohn's disease shows 70% of patients maintain stable, less severe disease over time, unlike the Montreal classification which suggests continuous progression.

Area of Science:

  • Gastroenterology and Hepatology
  • Inflammatory Bowel Disease Research
  • Clinical Epidemiology

Background:

  • The Montreal classification categorizes Crohn's disease (CD) behavior, focusing on disease progression towards stricturing and penetrating complications.
  • Clinical observations suggest CD complications can fluctuate, with potential for both worsening and improvement over time.

Purpose of the Study:

  • To introduce and validate the 'rolling phenotype' as an alternative model for describing the long-term course of Crohn's disease complications.
  • To compare the insights provided by the rolling phenotype model against the traditional cumulative Montreal classification.

Main Methods:

  • A retrospective analysis of 305 Crohn's disease patients with a minimum 5-year follow-up was conducted.
  • A 'rolling phenotype' was defined based on complications observed in the preceding three years at each time point.

Related Experiment Videos

  • Phenotypes (B1, B2, B3, B23) were assessed, and their progression under the rolling phenotype model was compared to the cumulative Montreal phenotype.

    • Main Results:

    • Longitudinal analysis using the rolling phenotype revealed stable proportions: 70% B1 (inflammatory), 20% B2 (stricturing), 5% B3 (penetrating), and 5% B23 (penetrating and stenotic).
    • These proportions remained consistent regardless of the patient's initial disease phenotype.
    • In contrast, the cumulative Montreal phenotype showed a progression towards more severe disease states over a 10-year period.

    Conclusions:

    • The rolling phenotype model offers a dynamic perspective on the burden of intra-abdominal complications in Crohn's disease.
    • This model indicates that a significant majority (70%) of patients experience sustained freedom from severe complications for over three years.