Crohn’s Disease: Classification

Montreal classification of Crohn’s disease.

Age of manifestation
  • A1: <16 years
  • A2: 17-40 years
  • A3: > 40 years
Localization
  • L1: ileum (ileum; part of the small intestine).
  • L2: colon (large intestine)
  • L3: Ileocolic
  • L4: Upper gastrointestinal tract (gastrointestinal tract).
Biological behavior
  • B1: non-stricting, non-penetrating.
  • B2: structuring
  • B3: internally penetrating
  • B4: perianal penetrating

Vienna classification of Crohn’s disease

Category A(age at confirmed diagnosis). A1 < 40 years
A2 > 40 years
Category L(localization; extent of disease localization at any time before first resection with a maximum of one allocation). L1 Terminal ileum (distal portion of the small intestine)
L2 Colon (large intestine)
L3 Ileum and colon
L4 Upper gastrointestinal tract (gastrointestinal tract)
Category B(Behavior; infestation pattern/clinical picture of the disease). B1 Inflammatory, nonpenetrating/nonstenosing phenotype.
B2 Stenosing phenotype
B3 Penetrating/ fistulating phenotype.

Crohńs Disease Activity Index (CDAI).

The following factors are used:

  • Number of soft stools
  • Intensity of abdominal pain
  • Extraintestinal (“outside the intestine”) manifestations.
  • Symptomatic diarrhea treatment
  • Resistance in the abdomen
  • Hematocrit (proportion of erythrocytes (red blood cells) in the volume of blood).
  • Body weight
  • General condition

The CDAI according to Best includes the following criteria:

Criteria Multiplier
Number of liquid chairs in the last 7 days Total x 2
Degree of abdominal pain

  • No pain on x days x 0 =.
  • Slight pain on x days x 1 =.
  • Moderate pain on x days x 2 =.
  • Severe pain on x days x 3 = please add it all up
 Total sum x 5
Degree of general condition during the last week

  • Good general condition on x days x 0 =.
  • Moderate general condition on x days x 1 =.
  • Poor condition on x days x 2 =.
  • Very bad feeling on x days x 3 =.
  • Unbearable condition on x days x 4 = please add everything up
 Total sum x 7
Symptoms coupled with IBD (extraintestinal manifestations).

  • Iritis (inflammation of the iris)/uveitis (inflammation of the medial eye skin).
  • Stomatitis aphthosa (“mouth rot”)
  • Pyoderma gangraenosum (painful disease of the skin in which ulceration or ulceration (ulceration or ulceration) and gangrene (tissue death due to reduced blood flow or other damage) occurs over a large area, usually in one place)
  • Erythema nodosum (synonyms: nodular erysipelas, dermatitis contusiformis, erythema contusiforme; plural: erythemata nodosa) – granulomatous inflammation of the subcutis (subcutaneous fat tissue), also known as panniculitis, and a painful nodule formation (red to blue-red color; later brownish). The overlying skin is reddened.Localization: both extensor sides of the lower leg, at the knee and ankle joints; less commonly on the arms or buttocks.
  • Arthralgia / arthritis (joint pain / joint inflammation).
  • Anal fissure / anal fistulas
  • Other fistulas
  • Temperature > 37 °C

Please add as appropriate (i.e. per symptom).

 Total x 20
Symptomatic therapy for diarrhea (opiate use).

  • Yes = 30
  • No = 0
Resistance in the abdomen (abdominal cavity)

  • No = 0
  • Questionable = 2
  • Certain = 5
 Sum x 10
Hematocrit

  • Men 47
  • Women 42

Difference from the determined hematocrit =.

 Result x 6
Weight1 – (body weight in kg/standard weight in kg) =. Result x 100
Total

Legend

  • > 150 points – acute thrust
  • > 450 points – very severe thrust
  • Decrease in score by 70 under therapy indicates success of therapy
  • < 150 points during the course of therapy speaks for remission (regression).