ArticleTherapeutic advances in gastroenterology2018
Different clinical outcomes in Crohn's disease patients with esophagogastroduodenal, jejunal, and proximal ileal disease involvement: is L4 truly a single phenotype?
Article in Therapeutic advances in gastroenterology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 24 citations in OpenAlex.
- Small bowel capsule endoscopy and treat-to-target in Crohn's disease: A systematic review.World journal of gastroenterology · 2019Pooled it
- Vedolizumab Achieves Pan-Enteric Mucosal Healing in Crohn's Disease: A Prospective Observational Study.United European gastroenterology journal · 2025Observational
- Upper Gastrointestinal Crohn's Disease: Shedding Light on the Obscure L4 Classification Meaning.Journal of clinical medicine · 2025Article
- Comparative analysis of enteroscopy, computed tomography enterography, and intestinal ultrasound for the evaluation of small bowel Crohn's disease.Therapeutic advances in gastroenterology · 2025Article
- Upper Gastrointestinal Involvement in Crohn's Disease as an Independent Predictor of New-Onset Strictures: Insights from an Extensive Retrospective Cohort Analysis.Digestive diseases and sciences · 2024Article
- A systematic review and meta-analysis of prevalence and clinical features of upper gastrointestinal (UGI) tract Crohn's disease in adults compared to non-UGI types.JGH open : an open access journal of gastroenterology and hepatology · 2023Review
- Gastroduodenal and Jejunoileal Crohn's Disease.Gastroenterology & hepatology · 2022Article
- Upper gastrointestinal tract involvement of Crohn disease: clinical implications in children and adolescents.Clinical and experimental pediatrics · 2022Article
- The GLIM Criteria Represent a More Appropriate Tool for Nutritional Assessment in Patients With Crohn's Disease.Frontiers in nutrition · 2022Article
- Crohn's disease patients with L4-esophagogastroduodenal phenotype is associated with a better prognosis: A retrospective cohort study.Frontiers in pharmacology · 2022Article
- Perianal disease onset age is associated with distinct disease features and need for intestinal resection in perianal Crohn's disease: a ten-year hospital-based observational study in China.BMC gastroenterology · 2021Observational
- Upper gastrointestinal tract involvement is more prevalent in Korean patients with pediatric Crohn's disease than in European patients.Scientific reports · 2020Article
- Body weight, serum albumin and food intolerance were linked to upper gastrointestinal Crohn's disease: a 7-year retrospective analysis.Annals of translational medicine · 2020Article
- Clinical Features and Prognosis of Crohn's Disease with Upper Gastrointestinal Tract Phenotype in Chinese Patients.Digestive diseases and sciences · 2019Observational
- Comparison of the use of wireless capsule endoscopy with magnetic resonance enterography in children with inflammatory bowel disease.World journal of gastroenterology · 2019Article
Corrections and comments
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Authors and funding
14 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe Montreal classification defines L4 Crohn's disease (CD) as any disease location proximal to the terminal ileum, which anatomically includes L4-esophagogastroduodenal (EGD), L4-jejunal, and L4-proximal ileal involvement. L4-jejunal disease was established to be associated with poor prognosis. However, the outcome of patients with L4-proximal ileal disease or L4-EGD remains to be clarified. Our study aimed to investigate whether the outcome differs among CD patients with L4-EGD, L4-jejunal, and L4-proximal ileal disease.
methodsIn our retrospective cohort study, 483 patients with confirmed CD were included. The primary outcome was intestinal surgery. Demographic features and outcomes were compared among L4-EGD, L4-jejunal, and L4-proximal ileal disease.
resultsThirty-nine (8.1%) patients had isolated L4 disease, whereas 146 patients had L4 as well as concomitant L1, L2, or L3 disease. During a median follow up of 5.8 years, L4 patients were more likely to have intestinal surgeries compared to non-L4 patients (31%
conclusionsL4 disease had worse prognosis compared to non-L4 disease. Within L4 disease, phenotype of L4-jejunal and L4-proximal ileal disease indicated higher risk for intestinal surgery. It might be justified to further characterize the L4 phenotype of the Montreal classification into three specific subgroups including L4-EGD, L4-jejunal, and L4-proximal ileal disease, similar to the Paris classification of pediatric patients.
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