Modificação do comportamento da doneça de Crohn baseada na classificação de Montreal, em centro de referência brasileiro para tratamento de doenças intestinais, no período de 20 anos de acompanhamento

Abstract

Crohns Disease (CD) is a chronic recurrent inflammatory condition of the gastrointestinal tract which can present with different phenotypes throughout its clinical course. It is believed that the inflammatory behavior is the initial presentation, which can evolve with time into a more complex disease, with stricturing or penetrating patterns. The aim of the study was to evaluate the behavior of CD over twenty years in a brazillian referral center for intestinal diseases and to assess the predictors of developing complications. One hundred and seventy patients with CD who fulfilled all the criteria were selected by retrospective analysis of medical records and were stratified according to the Montreal Classification at diagnosis and after 1, 3, 5, 10, 15 and 20 years of follow-up. Patients who had inflammatory behavior at diagnosis were included in the longitudinal retrospective study and assessed for the risk of developing complications using the Kaplan-Meier method. Variables such as gender, smoking, age of 40 or under, disease location, steroid dependence, early immunosuppression, biologic therapy and early surgery were analyzed as predictors of complications. At the time of diagnosis, 62.94% of the patients showed the inflammatory behavior, 22.35% had the stricturing pattern and 14.71% had penetrating disease. After ten years, 38.89% had maintained the inflammatory pattern and 61.11% had evolved to complications. The disease location, however, rema ined stable during the same period. After a medium follow-up of 7 years, 22.74% patients with inflammatory behavior at diagnosis developed stenosis or fistulas. Steroid dependence was the only predictor of the occurrence of complications. Our study allowed to conclude that more than 50% of the patients with CD evolve to strictur ing and/or penetrating behavior after 10 years of disease, but the disease location remains stable. The likelihood of developing complications is almost 20% after five years of diagnosis. Steroid dependence is a risk factor for developing complications.