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Review
. 2019 Dec;17(13):2634-2643.
doi: 10.1016/j.cgh.2019.04.040. Epub 2019 Apr 19.

Should We Divide Crohn's Disease Into Ileum-Dominant and Isolated Colonic Diseases?

Parambir S Dulai  1 , Siddharth Singh  2 , Niels Vande Casteele  2 , Brigid S Boland  2 , Jesus Rivera-Nieves  2 , Peter B Ernst  2 , Lars Eckmann  2 , Kim E Barrett  2 , John T Chang  2 , William J Sandborn  2
Affiliations
Review

Should We Divide Crohn's Disease Into Ileum-Dominant and Isolated Colonic Diseases?

Parambir S Dulai et al. Clin Gastroenterol Hepatol. 2019 Dec.

Abstract

Crohn's disease (CD) is an inflammatory bowel disease that can involve any region of the gastrointestinal tract. First described in 1932 as terminal ileitis or regional enteritis, it predominately involves the ileum with or without colonic involvement. Isolated colonic CD was first described in 1960 and since then the phenotypic classification of CD has evolved to stratify patients into isolated ileal, ileocolonic, or isolated colonic involvement. In the current review we evaluate the published literature regarding differences in epidemiology, natural history, pathogenesis, response to therapy, and disease monitoring, when stratified by disease location. Based on the available evidence consideration could be given to a new classification for CD, which splits it into ileum dominant (isolated ileal and ileocolonic) and isolated colonic disease. This may allow for a more optimized approach to clinical care and scientific research for CD.

Keywords: Classification; Colonic; Crohn's Disease; Ileal.

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Conflict of interest statement

Conflicts of interest: PSD: Consulting Takeda, Janssen, Prometheus; Research support Takeda, Janssen, Pfizer, Abbvie, Buhlmann, Polymedco; SS: Research support Abbvie, Pfizer; Consulting for Pfizer, Abbvie, Takeda, AMAG Pharmaceuticals; NVC: Consulting Boehringer Ingelheim, Takeda, Janssen, Pfizer, Progenity, Prometheus; Research support: R-Biopharm, Takeda, UCB. JTC: Grant support Takeda. JRN: Grant support Takeda. PBE: None. LE: Consultant for Orphagen Pharmaceuticals, lab service agreement with Takeda California. KEB: None. WJS: research grants from Atlantic Healthcare Limited, Amgen, Genentech, Gilead Sciences, Abbvie, Janssen, Takeda, Lilly, Celgene/Receptos; consulting fees from Abbvie, Allergan, Amgen, Arena Pharmaceuticals, Avexegen Therapeutics, BeiGene, Boehringer Ingelheim, Celgene, Celltrion, Conatus, Cosmo, Escalier Biosciences, Ferring, Forbion, Genentech, Gilead Sciences, Gossamer Bio, Incyte, Janssen, Kyowa Kirin Pharmaceutical Research, Landos Biopharma, Lilly, Oppilan Pharma, Otsuka, Prizer, Precision IBD, Progenity, Prometheus Laboratories, Reistone, Ritter Pharmaceuticals, Robarts Clinical Trials (owned by Health Academic Research Trust, HART), Series Therapeutics, Shire, Sienna Biopharmaceuticals, Sigmoid Biotechnologies, Sterna Biologicals, Sublimity Therapeutics, Takeda, Theravance Biopharma, Tigenix, Tillotts Pharma, UCB Pharma, Ventyx Biosciences, Vimalan Biosciences, Vivelix Pharmaceuticals; and stock or stock options from BeiGene, Escalier Biosciences, Gossamer Bio, Oppilan Pharma, Precision IBD, Progenity, Ritter Pharmaceuticals, Ventyx Biosciences, Vimalan Biosciences. Spouse: Opthotech - consultant, stock options; Progenity - consultant, stock; Oppilan Pharma - employee, stock options; Escalier Biosciences - employee, stock options; Precision IBD - employee, stock options; Ventyx Biosciences – employee, stock options; Vimalan Biosciences – employee, stock options.

Figures

Figure 1:
Figure 1:
Epidemiological and Pathogenic Associations Supporting Splitting of Crohn’s disease into Ileal-Dominant and Isolated Colonic Crohn’s disease
Figure 2:
Figure 2:
Meta-analysis of response to biologic agents stratified by disease location
Figure 3:
Figure 3:
Prior anatomic location of Crohn’s disease and proposed new classification
See this image and copyright information in PMC

References

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