Inflamm Bowel Dis. 2024 Mar 27:izae055. doi: 10.1093/ibd/izae055. Online ahead of print.

Charles N Bernstein ^1 2, Remo Panaccione ³, Zoann Nugent ^1 2, Deborah A Marshall ⁴, Gilaad G Kaplan ^3 4, Stephen Vanner ⁵, Levinus A Dieleman ⁶, Lesley A Graff ^2 7, Anthony Otley ⁸, Jennifer Jones ⁹, Michelle Buresi ³, Sanjay Murthy ¹⁰, Mark Borgaonkar ¹¹, Brian Bressler ¹², Alain Bitton ¹³, Kenneth Croitoru ¹⁴, Sacha Sidani ¹⁵, Aida Fernandes ¹⁶, Paul Moayyedi ¹⁶

Author information

¹Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.

²University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, Canada.

³Division of Gastroenterology and Hepatology, Departments of Medicine, University of Calgary, Calgary, Alberta, Canada.

⁴Departments of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.

⁵Queens University, Kingston, Ontario, Canada.

⁶Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.

⁷Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.

⁸Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.

⁹Department of Internal Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.

¹⁰Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

¹¹Department of Medicine, Memorial University, St Johns, Newfoundland, Canada.

¹²Department of Medicine, University of British Columbia, Vancouver, BC, Canada.

¹³Department of Medicine, McGill University, Montreal, Quebec, Canada.

¹⁴Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

¹⁵Department of Medicine, University of Montreal, Montreal, Quebec, Canada.

¹⁶Department of Medicine, McMaster University, Hamilton, Ontario, Canada.

Abstract

Background: We aimed to establish a cohort of persons with Crohn's disease (CD) enrolled from 14 Canadian centers to describe the contemporary presentation of CD in Canada.

Methods: All enrollees were at least 18 years old and underwent chart review for phenotype documentation by Montreal Classification at time of enrollment, comorbidities, inflammatory bowel disease (IBD) and other surgeries, and use IBD and other therapies.

Results: Of 2112 adults, 59% were female, and the mean age was 44.1 (+/-14.9SD) years. The phenotype distribution was B1 = 50.4%, B2 = 22.4%, B3 = 17.3%, and missing information = 9.9%. Perineal disease was present in 14.2%. Pertaining to disease location, 35.2% of patients had disease in L1, 16.8% in L2, 48% in L3, and 0.4% in L4. There was no difference in phenotype by gender, anxiety score, depression score. Disease duration was significantly different depending on disease behavior type (B1 = 12.2 ± 10.1; B2 = 19.4 ± 12.9; B3 = 18.9 ± 11.8, P < .0001). Isolated colonic disease was much less likely to be fibrostenotic or penetrating than inflammatory disease. Penetrating disease was more likely to be associated with ileocolonic location than other locations. Perineal disease was most commonly seen in persons with B3 disease behavior (24%) than other behaviors (11% B1; 20% B2 disease, P < .0001) and more likely to be seen in ileocolonic disease (L3;19%) vs L2 (17%) and L1 (11%; P < .0001). Surgery related to IBD occurred across each behavior types at the following rates: B1 = 23%, B2 = 64%, and B3 = 74%. Inflammatory bowel disease-related surgery rates by location of disease were L1 = 48%, L2 = 21%, and L3 = 51%.

Conclusions: In exploring this large contemporary CD cohort we have determined that inflammatory disease is the main CD phenotype in Canada and that CD-related surgery remains very common.