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Stenosis, fistulization, and perforation of the bowel are severe outcomes which can occur in patients with Crohn's disease. Accurate prediction of these events may enable clinicians to alter treatment strategies and avoid these outcomes.To study the correlation between longitudinal laboratory testing and subsequent intestinal complications in patients with Crohn's disease.An observational cohort of patients with Crohn's disease at a single center were analyzed between 01/01/1994 and 06/30/2016. A complication was defined as the development of an intestinal fistula, stenosis, or perforation. Exploratory analysis using Cox regression was performed to select the best statistical method to represent longitudinal laboratory data. Cox regression was used to identify laboratory variables independently associated with the development of a subsequent complication. A clinical scoring tool was designed.In 246 patients observed over a median of 5.72 years, 134 complications occurred. Minimum or maximum value in a preceding window period of one year was most strongly associated with subsequent complication. A Longitudinal Laboratory score of ≥ 2 (maximum albumin level 39 g/L = 1, maximum mean cell volume 88 fL = 1, minimum platelet count 355 × 10A consistent reduction in serum albumin and mean cell volume, and a consistent increase in platelet count and C reactive protein were associated with a subsequent complication in patients with Crohn's disease. Longitudinal laboratory tests may be used as described in this paper to provide a rational for earlier escalation of therapy.

Background Delays in Crohn's disease (CD) diagnosis are positively associated with ileal location and an increased risk of complications. Aim To develop a simple risk assessment tool to enable primary care physicians to recognise potential ileal CD earlier, shortening the delay to specialist investigation METHODS: Three cohorts were acquired for this study. Cohort 1 included 61 patients retrospectively identified with ileal CD between 2000 and 2010 and 78 matched controls drawn from a cohort referred for investigation of abdominal symptoms. Cohort 2 included 42 individuals diagnosed with ileal CD and 57 controls identified prospectively. Cohort 3 included an additional 84 individuals with ileal CD and 495 without CD referred for colonoscopy. Clinical symptoms and serological biomarkers were acquired and used to develop a risk prediction algorithm. The algorithm was trained independently on each of the three cohorts and tested on the latter two cohorts. Results Altered bowel habit with abdominal pain combined with derangements in white cell count (WCC), albumin and platelet counts were important features in predicting ileal CD (AUC = 0.92, 95% CI = 0.89-0.92). This was validated in cohorts 2 (AUC = 0.96, 95% CI = 0.95-0.98) and 3 (AUC = 0.94, 95% CI = 0.92-0.96). C-reactive protein was independently associated with ileal CD but non-signficant in a multivariate model. Conclusion A web-based risk stratification tool for ileal CD has been developed from objective and symptom-based criteria. This tool enables primary care physicians to more confidently request urgent specialist assessment for patients identified as at high risk for ileal CD.

Patients with inflammatory bowel disease (IBD) often have subjective symptoms for months or years prior to their diagnosis. Blood tests taken prior to diagnosis may provide objective evidence of duration of pre-diagnosis disease. We aim to describe the pre-diagnosis laboratory pattern of patients with IBD. A total of 838 patients diagnosed with IBD between 01/01/1996 and 01/03/2014, with pre-diagnosis laboratory testing available, contributed data for analysis. C-reactive protein, erythrocyte sedimentation rate, hemoglobin level, mean cell volume (MCV) platelet count, white blood cell count, neutrophil count, albumin level, ferritin level, serum iron level, alanine transaminase level, and fecal calprotectin were examined in the 24 months leading up to diagnosis and compared to baseline data taken between 24 and 36 months prior to diagnosis. For patients with Crohn’s disease, a significant drop in serum albumin and MCV levels and a significant rise in platelet count were observed between 115 and 385 days prior to diagnosis (p

Background and Aims This study aimed to characterize the mucosa-associated microbiota in ileal Crohn's disease [CD] patients and in healthy controls in terms of host genotype and inflammation status. Methods The mucosa-associated microbiotas of intestinal pinch biopsies from 15 ileal CD patients with mild and moderate disease and from 58 healthy controls were analysed based on 16S ribosomal sequencing to determine microbial profile differences between [1] IL23R, NOD2 and ATG16L1 genotypes in healthy subjects, [2] ileal CD patients and control subjects, and [3] inflamed and non-inflamed mucosal tissue in CD patients. Results The protective variant of the IL23R gene [rs11209026] significantly impacted the microbial composition in the ileum of healthy subjects and was associated with an increased abundance of phylotypes within the family Christensenellaceae as well as increases in diversity and richness. Comparative analysis of healthy and non-inflamed CD microbiome samples indicated a notable decrease in the abundance of Faecalibacterium prausnitzii as well as Shannon diversity and richness. Inflamed and non-inflamed ileal samples of CD subjects had high intra-individual stability and inter-individual variability, but no significant alterations in diversity, richness or taxa were identified. Calprotectin correlated positively with the abundance of Proteobacteria and negatively with diversity in the samples from healthy subjects. Conclusions The observation of low diversity and low abundance of beneficial bacteria in healthy control subjects carrying the IL23R [rs11209026] wild-type GG genotype indicates that the gut microbiome is influenced by host genetics and is altered prior to disease diagnosis. Faecal calprotectin may be a potential non-invasive screening tool for dysbiosis in subjects without disorders of intestinal inflammation.

Background Clostridioides difficile Infection (CDI) is a form of antibiotic associated infectious diarrhoea resulting in significant morbidity and mortality. Community acquired disease in low risk individuals is increasingly recognised. There are limited New Zealand data published. Aim To determine the incidence and location of onset of CDI cases in the Manawatu region, and further describe the demographics, risk factors and prevalent C. difficile ribotypes of the population. Methods We performed an incidence case-control study of CDI in the Manawatu region between September 2018 and September 2019. Cases were matched to controls with a negative test for C. difficile. Demographic and comorbidity data, location of onset, drug exposure, disease recurrence and 30-day mortality were collected. Ribotype analysis was performed on C. difficile isolates. Results 32 specimens tested toxin positive over twelve months, yielding an incidence of 18.3 cases per 100,000 person-years. 25% of cases had community onset disease. Cases were more likely to have had amoxicillin/clavulanate or ceftriaxone prescribed. Elevated blood white cell count and lower HbA1c were significantly associated with CDI. The dominant ribotype was 014/020, 2 cases were RT 023. Conclusion Our data are similar to previous national data. RT 023 has not been previously reported in New Zealand and has been associated with severe colitis. We demonstrated a significant proportion of community acquired cases and the true incidence may be higher. Vigilance for community onset disease is required. This data may allow observation of temporal changes in incidence and infection patterns of CDI in New Zealand. This article is protected by copyright. All rights reserved.

Sodium fluoroacetate (1080) is a highly toxic metabolic poison that has the potential because of its lack of defined color, odor, and taste and its high water solubility to be intentionally or unintentionally ingested through food adulteration. Although the mechanism of action for 1080 has been known since the 1950’s, no known antidote exists. In an effort to better understand the cardiopulmonary impacts of 1080, we utilized whole-body plethysmography and telemeterized Sprague-Dawley rats which allowed for the real-time measurement of respiratory and cardiac parameters following exposure using a non-invasive assisted-drinking method. Overall, the animals showed marked depression of respiratory parameters over the course of 24 hours post-exposure and the development of hemorrhage in the lung tissue. Tidal volume was reduced by 30% in males and 60% in females at 24 hours post-exposure, and respiratory frequency was significantly depressed as well. In telemeterized female rats, we observed severe cardiac abnormalities, highlighted by a 50% reduction in heart rate, 75% reduction in systolic blood pressure, and a 3.5-fold lengthening of the QRS interval over the course of 24 hours. We also observed a reduction in core body temperature of nearly 15°C. Our study was able to describe the severe and pronounced effects of sodium fluoroacetate poisoning on cardiopulmonary function, the results of which indicate that both tissue specific and systemic deficits contribute to the toxicological progression of 1080 intoxication and will need to be accounted for when developing any potential countermeasure for 1080 poisoning.

Background: Many patients presenting with an acute severe ulcerative colitis to a regional hospital are transferred to a metropolitan hospital for specialised care.Aims: To evaluate the outcomes and characteristics of these patients.Method: A retrospective observational cohort study was conducted to examine the 30-day colectomy rate using prospectively collected data on 69 consecutive index cases of acute severe ulcerative colitis transferred from regional hospitals to our metropolitan hospital meeting Truelove and Witts criteria. Those that avoided colectomy were followed out to 1 year to examine outcomes.Results: The 30-day colectomy rate was 46.4% (32/69) in regional transfer patients. Rescue therapy was administered to 65% (45/69) of patients after transfer to our metropolitan hospital. Colectomy was avoided in 55% of these patients at 30 days. Colectomy free status was maintained in 78%(29/39) of these patients. Mortality was 0% at 30 days and 1 year.Conclusion: Over 50% of the patients failing therapy in a regional centre and requiring transfer avoided short term colectomy with co-ordinated referral for rescue therapy in a tertiary metropolitan inflammatory bowel disease unit. These patients would have ultimately required colectomy in their regional hospital without intervention.

Background: Patients on immunosuppression at the time of acute severe ulcerative colitis have been suggested to be at a higher risk of colectomy than those who are treatment-naïve. The aim of this study was to examine the effect of immunosuppressive therapy on the risk of colectomy. Method: We conducted a retrospective observational cohort study using prospective data examining the 30 day and 1 year colectomy rates of 200 consecutive patients with an index episode of acute severe ulcerative colitis as defined by the Truelove and Witts criteria. Results: Immunosuppression on admission was shown not to increase colectomy rate at 30 days post-admission (immunomodulator: p = 0.422, oral steroids: p = 0.555). A total of 24 patients underwent colectomy between 30 days and 1 year. A three-fold higher risk of colectomy at 1 year was seen in those requiring an immunomodulator prior to the index admission compared with those started de novo during the index admission [41% versus 14% odds ratio (OR): 2.93 (1.19–7.24 p = 0.016)]. Factors most predictive of colectomy at 30 days were abdominal radiographic colonic dilation ⩾5.5 cm, first presentation of ulcerative colitis, C-reactive protein ⩾ 45 mg/l on day 3 of therapy and bowel frequency ⩾8 on day 3. Conclusion: The need for an immunomodulator prior to admission with acute severe ulcerative colitis increases the medium-term colectomy rate by three-fold at 1 year. Prospective studies are needed to confirm these findings and develop strategies to reduce the high risk in this subgroup of patients.

Background To date no incidence figures for upper gastrointestinal haemorrhage (UGIH) in New Zealand have been published. Aims To determine the incidence of UGIH in a demographically defined population, and to assess variation in incidence associated with demographic parameters. Methods Between 17 March 2001 and 12 October 2010, all patients presenting to Waikato Hospital with UGIH were prospectively ascertained, and clinical, epidemiological and laboratory data were collected. Incidence rates were calculated, and were age adjusted to the World Health Organization world standard population. Parameters associated with trends in incidence were examined. Results There were 1360 UGIH events, yielding a crude incidence of 59.2 per 100 000 adults (age ≥ 15 years) per year (all quoted incidence figures per 100 000 adults per year), and an age-adjusted incidence (AAI) of 46.4. AAI was higher for Maori compared with New Zealand Europeans (91.3 vs 37.0, rate ratio (RR) = 2.47, P < 0.001). Maori were more likely to have a gastric ulcer at endoscopy (odds ratio (OR) = 2.21, P < 0.001). For those tested for Helicobacter pylori (n = 702), Maori were more likely to be infected (OR = 2.12, P < 0.001). AAI was higher for males (61.1 vs 33.6, RR = 1.82, P < 0.001). Males were more likely to have a duodenal ulcer at endoscopy (OR = 1.79, P < 0.001). AAI incidence decreased from the first to the second half of the study period (53.6 vs 45.8, RR = 1.17, P < 0.001). Conclusion AAI of UGIH in the Waikato region was 46.4. This was significantly higher in Maori and in males, and decreased over the study period. These data will provide a comparison for future assessment of trends in UGIH.

No two robots are exactly the same—even for a given model of robot, different units will require slightly different controllers. Furthermore, because robots change and degrade over time, a controller will need to change over time to remain optimal. This paper leverages lifelong learning in order to learn controllers for different robots. In particular, we show that by learning a set of control policies over robots with different (unknown) motion models, we can quickly adapt to changes in the robot, or learn a controller for a new robot with a unique set of disturbances. Furthermore, the approach is completely model-free, allowing us to apply this method to robots that have not, or cannot, be fully modeled.

Sodium fluoroacetate (1080) is a highly toxic metabolic poison that has the potential because of its lack of defined color, odor, and taste and its high water solubility to be intentionally or unintentionally ingested through food adulteration. Although the mechanism of action for 1080 has been known since the 1950s, no known antidote exists. In an effort to better understand the cardiopulmonary impacts of 1080, we utilized whole-body plethysmography and telemeterized Sprague-Dawley rats which allowed for the real-time measurement of respiratory and cardiac parameters following exposure using a non-invasive assisted-drinking method. Overall, the animals showed marked depression of respiratory parameters over the course of 24 h post-exposure and the development of hemorrhage in the lung tissue. Tidal volume was reduced by 30% in males and 60% in females at 24 h post-exposure, and respiratory frequency was significantly depressed as well. In telemeterized female rats, we observed severe cardiac abnormalities, highlighted by a 50% reduction in heart rate, 75% reduction in systolic blood pressure, and a 3.5-fold lengthening of the QRS interval over the course of 24 h. We also observed a reduction in core body temperature of nearly 15°C. Our study was able to describe the severe and pronounced effects of sodium fluoroacetate poisoning on cardiopulmonary function, the results of which indicate that both tissue specific and systemic deficits contribute to the toxicological progression of 1080 intoxication and will need to be accounted for when developing any potential countermeasure for 1080 poisoning.

Crohnrs disease is a chronic inflammatory condition of the human gastrointestinal tract. It affects approximately one in five hundred individuals in Australia, predominantly young adults. It can cause significant morbidity from bowel obstruction, bowel perforation, perianal abscess or perianal fistula formation, or chronic bowel inflammation. A significant proportion of patients with Crohnrs disease develop irreversible bowel damage, damage which requires surgical resection of the affected bowel to relieve symptoms. Medical therapies used to treat Crohnrs disease modify the host immune system and reduce bowel inflammation, reducing symptoms of pain and diarrhoea, and possibly reducing progression to irreversible bowel damage. Medical therapies increase the risk of opportunistic infection, the risk of developing skin cancer or lymphoma, and carry a risk of drug induced effects such as hepatitis or bone marrow suppression. These risks are likely to increase with increasing strength of immunosuppression. Therapy in Crohnrs disease needs to appropriately weigh risks and benefits for individual patients. Accurate and objective prediction of likely outcome for patients with Crohnrs disease would aid in selection of appropriate therapy. This body of work aimed to define objective, longitudinal tools to improve prediction of outcome in Crohnrs disease. There were two critical features which defined our approach in this work. The first was the recording of objective clinical data in a longitudinal fashion. This was achieved by designing a database with dated datafields, and endeavoring to minimize subjectivity in datapoint recording. Further objective longitudinal data were obtained through data linkage to laboratory databases. The second feature was definition of an outcome which was reversible. This feature of outcome definition meant that analysis of longitudinal information was able to occur at many timepoints in a patientrs disease course. A poor outcome was defined as the formation of a bowel stenosis, perforation or fistula. Resolution of an outcome was defined as the passage of 2 years without further observation of the outcome. Resolution could occur following surgery, or passively with the passage of time. Perianal fistula formation was considered as an independent outcome in a separate analysis. A consistently low albumin level l 37 g/L -1, a platelet count g370 x109/L, an MCV l 86 fL and a neutrophil count g8.6 x109 /L were identified to be associated with subsequent bowel stenosis, fistula formation or perforation. Additionally, an albumin level consistently l 38 g/L -1 or a CRP consistently g 11 mg/L-1 were associated with subsequent perianal fistula formation. This information may lead to enhanced outcome prediction in Crohnrs disease, and improved tailoring of therapy for individual patients. These findings require validation in an external cohort.

Background and aim: The Montreal classification of disease behaviour in Crohn's disease describes progression of disease towards a stricturing and penetrating phenotype. In the present paper, we propose an alternative representation of the long-term course of Crohn's disease complications, the rolling phenotype. As is commonly observed in clinical practice, this definition allows progression to a more severe phenotype (stricturing, penetrating) but also, regression to a less severe behaviour (inflammatory, or remission) over time. Methods: All patients diagnosed with Crohn's Disease between 01/01/1994 and 01/03/2008, managed at a single centre and observed for a minimum of 5 years, had development and resolution of all complications recorded. A rolling phenotype was defined at each time point based on all observed complications in the three years prior to the time point. Phenotype was defined as B1, B2, B3, or B23 (penetrating and stenotic). The progression over time of the rolling phenotype was compared to that of the cumulative Montreal phenotype. Results: 305 patients were observed a median of 10.0 (Intraquartile range 7.3-13.7) years. Longitudinal progression of rolling phenotype demonstrated a consistent proportion of patients with B1 (70%), B2 (20%), B3 (5%) and B23 (5%) phenotypes. These proportions were observed regardless of initial phenotype. In contrast, the cumulative Montreal phenotype progressed towards a more severe phenotype with time (B1 (39%), B2 (26%), B3(35%) at 10 years). Conclusion: A rolling phenotype provides an alternative view of the longitudinal burden of intra-abdominal complications in Crohn's disease. From this viewpoint, 70% of patients have durable freedom from complication over time (>3 years).

Introduction: Warfarin is a widely used and easily reversible anticoagulant. Although bleeding is more likely in warfarin users, it may also be more readily treated. This retrospective observational case-control study compares the outcome of acute nonvariceal upper gastrointestinal hemorrhage in warfarin users with a supratherapeutic international normalized ratio (INR) and outcome in non – warfarin users. Patients and methods: Clinical and endoscopic data for patients presenting with overt upper gastrointestinal hemorrhage were collected between 23rd February 2001 and 12 October 2010. Patients with variceal hemorrhage were excluded. Warfarin users with a supratherapeutic INR (≥ 3.0) at presentation (supratherapeutic anticoagulation [SA] group) were matched to a cohort with upper gastrointestinal hemorrhage not taking warfarin at presentation (control group). Patients were matched by age, sex, Rockall score, year of endoscopy, inpatient or outpatient status, and the presence of disseminated cancer at presentation. The incidence rates of major outcomes in the two groups were compared. Results: A total of 128 patients (SA group) were matched to 135 control patients. The SA group patients were less likely to die within 30 days (6.25 % vs. 15.5 %, odds ratio = 0.36, P = 0.028 by Test for Equality of Proportions). There was a trend toward more surgery in the control group (5 % vs. 2 %), and rates of blood transfusion (77 % vs. 70 %) were similar in the two groups. Conclusion: In patients presenting with nonvariceal upper gastrointestinal hemorrhage, a supratherapeutic INR at presentation due to warfarin use is associated with reduced mortality.

In patients with upper gastrointestinal haemorrhage (UGIH), endoscopic treatment of high-risk lesions reduces mortality. Performing out of office hours endoscopy places a strain on endoscopy services. This analysis aims to identify factors at presentation associated with lesions requiring endoscopic therapy, allowing triage of those likely to receive benefit from acute out of hours endoscopy.Patients presenting between 17 March 2001 and 12 October 2010 with UGIH had clinical and laboratory features on presentation, endoscopic findings and administered treatment recorded. Patients with known cirrhotic liver disease were excluded. Logistic regression was performed, identifying factors at presentation associated with a requirement of endoscopic therapy (RET), which were then used to create a scoring system predictive of RET.In all, 1492 patients were analysed. The presence on presentation of fresh melaena (OR = 3.18, p0.001), fresh haematemesis (OR=2.13, p0.001), haemoglobin130 g/L (OR=2.65, p0.001), urea10 mmol/L (OR=2.10, p0.001), systolic blood pressure100 mm Hg (OR=1.85, p0.001), inpatient status (OR=1.43, p=0.04), a history of peptic ulcer disease (OR=1.96, p=0.02), male sex (OR=1.45, p=0.01), presentation within 8 h of symptom onset (OR=1.48, p=0.02), coffee ground vomitus (OR=0.47, p=0.004) and warfarin use (OR=0.57, p=0.005) were associated with RET. Using a simple scoring system (fresh haematemesis=2, fresh melaena=2, haemoglobin130=2, urea10=1, BP100=1, male sex=1, history of peptic ulcer disease=1), a score ≥7 was associated with RET in 45% of cases and a score ≤4 in 7%.Application of this scoring system when assessing patients presenting with UGIH out of office hours may help predict the likelihood of RET, and aid in the triage of endoscopy. Prospective validation of this score in an external cohort is required.

Coded excitation and pulse compression techniques have been used to improve the echo signal-to-noise ratio (eSNR) in ultrasonic imaging. However, most hardware use phase modulated codes over frequency modulated codes because of ease of implementation. In this study, a technique that converts non-binary frequency modulated codes into binary frequency modulated codes is evaluated. To convert from a non-binary to a binary code, a second-order, one-bit sigma delta modulator is used. This sigma-delta modulated code is generated in MATLAB which is then stored in a double data rate synchronous dynamic random access memory. A field programmable gate array, which has access to the memory device, transmits the binary waveform and is recorded using an oscilloscope. The recorded data is then filtered using the pulse-echo transducer model of a linear array with a center frequency of 8.4 MHz and a fractional bandwidth of 100% at -6 dB. Pulse compression was then performed using a matched filter, a mismatched filter, and a Wiener filter. Image quality metrics, such as modulation transfer function and sidelobe-to-mainlobe ratio, were used to assess compression performance. Overall, echoes compressed when the excitation is the sigma-delta modulated coded waveform resulted in no measurable difference in axial resolution.

To determine the incidence, and any change in incidence, of spontaneous intracerebral haemorrhage (ICH) detected in the hospitals of the Waikato region of New Zealand (NZ) between 1999 and 2008. To analyse clinical and patient parameters, and to correlate these with outcome.A retrospective analysis was performed on patients presenting to Waikato and Thames Hospitals with ICH during the study period. Radiology reports, blood tests and the electronic clinical record were reviewed for each patient.653 episodes of ICH were identified. The average annual incidence per 100,000 per year was 17.4 (16.1-18.7, 95% confidence interval). This increased from an average of 14.4 (13.7-15.1) between 1999-2001 to 21.4 (20.6-22.2) between 2006-2008 (rate ratio 1.49, p0.0001). 249 (38.1%) patients died within 30 days of their sentinel bleed. The presence of intraventricular extension of bleed on neuroimaging (Odds Ratio (OR) 6.18, p0.001), warfarin use (OR 1.11, p=0.76), warfarin use and intraventricular extension of bleed (OR 23.8, p=0.014), lobar location of bleed (OR 1.88, p=0.001) and age (OR 1.16 for every 10-year increase in age, p=0.02) increased the likelihood of death within 30 days.Observed ICH has increased in incidence in our hospitals over the past 10 years. Increasing availability of neuroimaging, increasing numbers of elderly, and increasing warfarin associated ICH were likely contributors to this observed increase. Radiological evidence of extension of intraventricular bleed, warfarin use, lobar location of bleed, and increasing age correlated with poorer survival. This data will be available for comparison with future studies to assess trends in incidence, patient characteristics and outcome in ICH.

The shared online calendar is the de facto standard for event organisation and management in the modern office environment. It is also a potentially valuable source of context, provided the calendar event data represent an accurate account of 'real-world' events. However, as we show through a field study, the calendar does not represent reality well as genuine events are hidden by a multitude of reminders and 'placeholders', i.e. events that appear in the calendar but do not occur. We show that the calendar's representation of real events can be significantly improved through data fusion with other sources of context, namely social network and location data. Finally, we discuss some of the issues raised during our field study, their significance and how performance could be farther improved.

There are two main ways to protect cultural heritage objects from air pollution damage. First, by reducing ambient levels of air pollution and second, by instigating local management strategies tha ...

BACKGROUND: The Montreal classification for patients with Crohn's disease describes disease phenotype in a hierarchy: B1 (Inflammatory), B2 (Stricturing), B3 (Internal Penetrating). It does not make allowance for description of resolution, or of repeated development, of internal penetrating or stricturing complications (IPSC). It therefore always observes increasing severity of disease phenotype over time, and does not accurately represent the burden of IPSC later in the disease course. AIM: To describe a novel classification of longitudinal disease phenotype in Crohn's disease, which allows description of both resolution and repeated development of IPSC. METHODS: Patients diagnosed at a tertiary referral centre (Brisbane, Australia) with Crohn's disease between 1st Jan 1994 and 1st March 2008, with more than five years of clinical follow-up, had all objective clinical data recorded in a longitudinal database. Temporal evidence of presence of IPSC was obtained from the following: computed tomographic enterography (CTE), magnetic resonance enterography (MRE), ileocolonoscopy, gastroscopy, findings at abdominal surgery and examination of macroscopic surgical specimens. Disease phenotype at each time point was classified as the presence or absence of IPSC over the previous three years of disease course. Longitudinal disease phenotype was compared to progressive Montreal phenotype. Subgroup analysis was performed for patients with B1, B2 or B3 Montreal phenotype within one year of diagnosis. RESULTS: 316 patients with a median follow-up of 10.0 years (interquartile range (IQR) 6.81 13.67) were analyzed. Mean age at diagnosis was 27.4 years and 55% were female. Montreal location classification at diagnosis was L1 (131 patients), L2 (58) and L3 (117). Progressive Montreal phenotype was comparable to published cohorts.1 In comparison longitudinal phenotype classification demonstrated a predominance of stricturing complications. Stricturing complications predominated regardless of Montreal phenotype within the first year (graphs not shown). The steep slope in all lines at 3 years represents patients with an isolated IPSC at presentation regressing to a less severe classification. CONCLUSION: B2 (Stricturing) complications make up the bulk of recurring or non-resolving IPSC in patients with Crohn's disease, regardless of Montreal phenotype within one year of diagnosis. This is not evident when disease classification is observed using the Montreal classification system alone. 1: Tarrant KM, Barclay ML, Frampton CMA, Gearry RB. Perianal disease predicts changes in Crohn's disease phenotype-results of a population-based study of inflammatory bowel disease phenotype. Am J Gastroenterol. 2008 Dec;103(12):3082-93.

in the use of systemic steroids. Conclusions: At the moment of diagnosis of CD, smoking, abdominal pain, diarrhea, lower hemoglobin values and higher CPR, ESR or platelet values, as well as ileocolonic location of the disease, penetrating or stricturing disease, and perianal involvement are associated with a subsequent surgical outcome. The early recognition of these features in newly diagnosed patients should be seriously taken into account when deciding for more aggressive medical treatments, such as immunosuppressors or biological agents, in order to defer the more invasive surgical procedures.

BACKGROUND: The Montreal classification for patients with Crohn's disease describes disease phenotype in a hierarchy: B1 (Inflammatory), B2 (Stricturing), B3 (Internal Penetrating). It does not make allowance for description of resolution, or of repeated development, of internal penetrating or stricturing complications (IPSC). It therefore always observes increasing severity of disease phenotype over time, and does not accurately represent the burden of IPSC later in the disease course. AIM: To describe a novel classification of longitudinal disease phenotype in Crohn's disease, which allows description of both resolution and repeated development of IPSC. METHODS: Patients diagnosed at a tertiary referral centre (Brisbane, Australia) with Crohn's disease between 1st Jan 1994 and 1st March 2008, with more than five years of clinical follow-up, had all objective clinical data recorded in a longitudinal database. Temporal evidence of presence of IPSC was obtained from the following: computed tomographic enterography (CTE), magnetic resonance enterography (MRE), ileocolonoscopy, gastroscopy, findings at abdominal surgery and examination of macroscopic surgical specimens. Disease phenotype at each time point was classified as the presence or absence of IPSC over the previous three years of disease course. Longitudinal disease phenotype was compared to progressive Montreal phenotype. Subgroup analysis was performed for patients with B1, B2 or B3 Montreal phenotype within one year of diagnosis. RESULTS: 316 patients with a median follow-up of 10.0 years (interquartile range (IQR) 6.81 13.67) were analyzed. Mean age at diagnosis was 27.4 years and 55% were female. Montreal location classification at diagnosis was L1 (131 patients), L2 (58) and L3 (117). Progressive Montreal phenotype was comparable to published cohorts.1 In comparison longitudinal phenotype classification demonstrated a predominance of stricturing complications. Stricturing complications predominated regardless of Montreal phenotype within the first year (graphs not shown). The steep slope in all lines at 3 years represents patients with an isolated IPSC at presentation regressing to a less severe classification. CONCLUSION: B2 (Stricturing) complications make up the bulk of recurring or non-resolving IPSC in patients with Crohn's disease, regardless of Montreal phenotype within one year of diagnosis. This is not evident when disease classification is observed using the Montreal classification system alone. 1: Tarrant KM, Barclay ML, Frampton CMA, Gearry RB. Perianal disease predicts changes in Crohn's disease phenotype-results of a population-based study of inflammatory bowel disease phenotype. Am J Gastroenterol. 2008 Dec;103(12):3082-93.