Clinical predictors of Crohn's disease course.

A modern approach to Crohn's disease (CD) should be influenced by the patient's underlying prognosis. Here, I analyse the clinical factors predicting CD course on the basis of information obtained at diagnosis and in the year following diagnosis. Perianal disease at diagnosis appears to be a strong predictor of unfavourable outcome and has been associated with a more frequent use of immunosuppressive treatment. Early age at diagnosis, ileocolonic disease and extraintestinal manifestations are characteristics of patients at risk for more complicated disease. Otherwise, patients subjected to surgery at diagnosis or during the first year of follow-up appear to have a relatively benign outcome. Disease activity in the year after diagnosis appears to be a good predictor of future disease activity as about two-third of the patients who remain in remission tend to remain unchanged thereafter, whereas those patients treated with steroids have, manifestly, an unfavourable subsequent clinical course. Moreover, there is consistent evidence that active smoking is associated with a complicated disease course. The results of the studies reviewed suggest that the combination of 'phenotype at diagnosis' and 'comportment follow-up classification' in the year following diagnosis can be potentially useful prognostic factors in clinical practice. With the development of newer therapies in CD, there is a growing need to predict disease outcome, despite the difficult challenge in anticipating the future clinical course in a given patient.

Budesonide and mesalazine in active Crohn's disease: a comparison of the effects on quality of life.

OBJECTIVES: Controlled ileal release budesonide and slow release mesalazine are both used to treat mild to moderate active Crohn's disease, although data show that budesonide is more effective in inducing remission. When comparing different treatment options, the effects of agents on health-related quality of life must be considered as well as efficacy. In this study, we sought to compare the effects of budesonide and mesalazine on the health-related quality of life of patients with active Crohn's disease. METHODS: The study included 182 patients with Crohn's Disease Activity Index scores between 200 and 400. Patients were randomized in a double blind, double dummy, multicenter study to receive 9 mg of budesonide, once daily (n = 93), or 2 g of mesalazine, b.i.d. (n = 89), for 16 wk. Quality of life was assessed at baseline and after 2, 4, 8, 12, and 16 wk of treatment using the Psychological General Well-Being index. In addition, a physician's global evaluation was used to assess how symptoms affected patients' normal activities. RESULTS: Patients treated with budesonide experienced significantly greater improvement in Psychological General Well-Being scores than the group treated with mesalazine after 2, 8, 12, and 16 wk. All components of this index showed greater improvements in the budesonide-treated group than in the mesalazine group at 12 and 16 wk. The physician's global evaluation showed significantly greater improvements in the budesonide group than in the mesalazine group at all visits. CONCLUSION: Budesonide (9 mg once daily) improves health-related quality of life to a greater extent than mesalazine (2 g b.i.d.) in patients with mild to moderate active Crohn's disease.