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6. Paediatric modification of the Montreal Classification for inflammatory bowel disease – the Paris classification

A. Levine1, A.M. Griffiths2, J. Markowitz3, D. Wilson4, D. Turner5, R. Russell6, J.E.M. Fell7, F. Ruemmele8, T. Walters2, M. Dubinsky9, J. Hyams10

1Wolfson Medical Center, Tel Aviv, Israel; 2Hospital for SickKids, Toronto, ON, Canada; 3Cohen Children's Medical Center of New York, New York, NY, United States; 4Royal Hospital for Sick Children, Edinburgh, United Kingdom; 5Shaare Zedek Medical Center, Jerusalem, Israel; 6Royal Hospital for Sick Children, Glasgow, United Kingdom; 7Imperial College, London, United Kingdom; 8Hôpital Necker Enfant Malade, Paris, France; 9Cedars Sinai, Los Angeles, CA, United States; 10Connecticut Children's Medical Center, Hartford, CT, United States

As the genetic basis of IBD has been explored, it has become clear that Crohn's disease and ulcerative colitis are complex disorders with some shared and many unique predisposing genes. Accurate phenotype classification is essential if the utility of genotypic data in predicting clinical variability is to be assessed. The Montreal classification of inflammatory bowel disease (IBD) has several weaknesses with respect to classification of young patients. The dynamic features of pediatric disease phenotype (change in disease location and behavior over time, growth failure) are not sufficiently captured by the current Montreal classification. With a specific focus on facilitating research in pediatric IBD, and creating uniform standards for defining IBD phenotypes, an international group of pediatric IBD experts met to develop evidence-based consensus recommendations for a pediatric modification of the Montreal criteria. Age of onset appears to influence phenotype both in Crohn's disease and Ulcerative colitis, and disease behavior in ulcerative colitis. Important modifications to the Montreal classification developed include classifying age at diagnosis as A1a (0 to <10 years), A1b (10 to <17 years), A2 (17 to 40 years) and A3 (>40 years), distinguishing disease above the distal ileum as L4 (proximal to ligament of Treitz) and L5 (Ligament of Treitz to above distal ileum), allowing both stenosing and penetrating disease to be classified in the same patient (B2B3), denoting the presence of growth failure in the patient at any time as G1 versus G0 (never growth failure), and adding E4 to denote extent of ulcerative colitis that is proximal to the hepatic flexure. These modifications better reflect IBD in children and are termed the Paris classification.