Crohn's Disease Phenotypes and Associations With Comorbidities, Surgery Risk, Medications and Nonmedication Approaches: The MAGIC in IMAGINE Study

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


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


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.

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