Clinical factors predicting disease course in Crohn's disease

Evaluation of: Lakatos PL, Czegledi Z, Szamosi T et al. Perianal disease, small bowel disease, smoking, prior steroid or early azathioprine/biological therapy are predictors of disease behavior change in patients with Crohn's disease. World J. Gastroenterology 15(28), 3504-3510 (2009). Crohn's disease (CD) is a chronic inflammatory bowel disease of uncertain etiology that is clinically heterogeneous and displays phenotypic change over time. With the advent of increasingly effective medical therapies, considerable research has focused on identifying patients at risk of developing a complicated course who could be targeted for early aggressive therapy. The evaluated paper identified several clinical factors associated with progression to complicated intestinal disease, including perianal disease, smoking, steroid use and early azathioprine therapy. In addition, it demonstrated that ileal disease, perianal disease, steroid use and smoking were associated with a more rapid progression to complicated disease. These results are consistent with previous work and provide evidence that early immunosuppressive use may potentially modify the natural history of CD in certain patients. The current role of clinical factors, serologic and genetic biomarkers in providing prognostic information in CD is discussed.