Volume 71 - 2008 - Fasc.3 - Symposium
Crohn's disease phenotype, prognosis, and long-term complications : what to expect ?
According to Montreal classification, different phenotypes of Crohn's disease are defined taking into account age at diagnosis, localization of digestive lesions at first surgery, and cumulative anatomical behaviour. This classification is supported by the increased severity of the disease when diagnosed in childhood, the relative stability of disease localization over time, and the clinical importance of intestinal complications as stricture and abscess or fistula formation. However, type and delay of complications are dependent on disease localization (they develop early in small bowel disease and late in colitis), every patient will develop compli- cations one day, and perianal disease may be an important prob- lem observed in up to half the patients. The percentage of patients with active disease every year remains stable, about 40%, after the 3 first years, and only a few patients have long periods of remission. Intestinal resections are required in the majority of patients during life, and many are operated on several times. Prognosis is ham- pered by iterative surgery, cancer and side-effects of treatment. Standardized mortality ratio is 1.5O.Although occurrence of complications, need for surgery and mortality did not change significantly through the years 1950-2000, there are some signals suggesting that new therapetic strategies (immunosuppressants earlier in high risk patients) and biologics will modify natural history and improve the long term prognosis. (Acta gastroenterol. belg., 2008, 71, 303-307).
Molecular imaging in a (pre-) clinical context
Molecular imaging can be defined as imaging of biological processes in a living organism at the molecular and/or cellular level. To achieve this goal, genetic information and new chemistries have to be combined into new imaging probes detectable by sophis- ticated imaging techniques. In contradistinction to conventional imaging, which mostly detects architectural, or morphological dis- tortions (a late event), molecular imaging should be able to detect molecular changes that are at the basis of diseases. The detection of subtle pathologic changes in early, asymptomatic disease should have a tremendous impact on healthcare as a whole. (Acta gastro- enterol. belg., 2008, 71, 308-317).
