Da Classificação de Viena para a Nova Classificação de Montreal: Caracterização Fenotípica e Evolução Clínica da Doença de Crohn

 

Ana Rebelo, Bruno Rosa, Maria João Moreira, José Cotter

Serviço de Gastrenterologia do Centro Hospitalar do Alto Ave – Guimarães

Correspondência

 

Resumo

A Classificação de Montreal (CM) sucedeu à de Viena (CV) na caracterização dos doentes com Doença de Crohn (DC).

Com o objectivo de avaliar as diferenças e potenciais vantagens da primeira em relação à última e validar a CM através da análise longitudinal da variação fenotípica desta população, analisaram-se retrospectivamente 122 doentes com DC classificados segundo as CV e CM. Avaliou-se a evolução dos subgrupos e a necessidade de cirurgia. Nos resultados verificou-se que a CM reclassificou 6 doentes no critério idade de diagnóstico (A), 4 no critério localização (L) e 18 no critério comportamento (B). A localização (L) da doença permaneceu estável. O comportamento (B) pela CV modificou-se aos 3 e 5 anos. Foram submetidos a cirurgia major 41,8% dos doentes. Identificou-se uma maior associação entre a necessidade de cirurgia e o grupo B3 da CM. Não se verificaram diferenças estatisticamente significativas entre as curvas de sobrevivência e as variáveis sexo, tabaco e idade de diagnóstico.

Conclusão: A CM é mais sensível na avaliação fenotípica do comportamento da doença, principalmente após a exclusão da doença perianal da categoria doença penetrante. A classificação da DC por padrão fenotípico poderá eventualmente, no futuro, ser aplicada para predizer a sua história natural.

PALAVRAS-CHAVE: Doença de Crohn, classificação de Viena, classificação de Montreal.

 

From the Vienna Classification to the New Montreal Classification: Phenotype Characterization and Clinical Evolution of Crohn´s Disease

Abstract

Montreal classification (MC) succeeded Vienna classification (VC) in the characterization of patients with Crohn´s disease (CD).

In order to evaluate the differences and potential advantages of the first regarding the last one and validate the MC through the longitudinal analysis of the phenotypic variation of this population, 122 Crohn´s patients were retrospectively analyzed and classified according to both classifications. The evolution of both subgroups and the need for surgery was analysed. Results showed that MC reclassified 6 patients in the criteria age at diagnosis (A), 4 in the criteria location (L) and 18 in the criteria behaviour (B). The disease location (L) remained stable. The behaviour (B) by the VC classification changed at 3 and 5 years. 41,8% of patients underwent major surgery. A higher association between the need for surgery and the group B3 of MC was identified. There were no statistically significant differences between the survival curves and sex, smoking and age at diagnosis.

Conclusion: The MC is more sensitive in the phenotypic evaluation of behaviour of CD, especially after exclusion of perianal disease from the category penetrating disease. The classification of CD by phenotypic pattern could possibly, in future, be applied to predict its natural history.

KEYWORDS: Crohn’s Disease, Vienna classification, Montreal classification.

 

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Correspondência:

Ana Isabel Castro de Sampaio Rebelo;

Serviço de Gastrenterologia do Centro Hospitalar do Alto Ave, E.P.E.;

Rua dos Cutileiros, Creixomil

4835 044 Guimarães - Portugal;

Telefone: +351 253 540 330, Fax: +351 253 421 308;

E-mail: airebelo_@hotmail.com

 

Recebido para publicação: 19/05/2010 e Aceite para publicação: 28/09/2010.