{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T11:15:24Z","timestamp":1793445324667,"version":"4.5.0"},"reference-count":34,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2018,1,1]],"date-time":"2018-01-01T00:00:00Z","timestamp":1514764800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Therap Adv Gastroenterol"],"published-print":{"date-parts":[[2018,1,1]]},"abstract":"<jats:sec><jats:title>Background:<\/jats:title><jats:p> The Montreal classification defines L4 Crohn\u2019s 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. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods:<\/jats:title><jats:p> In 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. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p> Thirty-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% versus 16%, p &lt; 0.001). The percentage of L4-jejunal patients who underwent surgery was higher than that of L4-proximal ileal (66% versus 28%, p &lt; 0.001), and both of these subtypes of L4 were at higher risk for intestinal resection compared to L4-EGD patients (66% and 28% versus 9%, respectively, p &lt; 0.001 and p &lt; 0.05). On multi-variable analysis, L4-jejunal (HR 3.08; 95% CI 1.30\u20137.31) and L4-proximal ileal disease (HR 1.83; 95% CI 1.07\u20133.15) were independent predictors for intestinal resection. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions:<\/jats:title><jats:p> L4 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. <\/jats:p><\/jats:sec>","DOI":"10.1177\/1756284818777938","type":"journal-article","created":{"date-parts":[[2018,6,5]],"date-time":"2018-06-05T10:14:31Z","timestamp":1528193671000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":19,"title":["Different clinical outcomes in Crohn\u2019s disease patients with           esophagogastroduodenal, jejunal, and proximal ileal disease involvement: is L4 truly a           single phenotype?"],"prefix":"10.1177","volume":"11","author":[{"given":"Ren","family":"Mao","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated\r            Hospital, Sun Yat-sen University, 58 Zhongshan II Road, Guangzhou, 510080, People\u2019s\r            Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui-Han","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated\r            Hospital, Sun Yat-sen University, Guangzhou, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Qiu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated\r            Hospital, Sun Yat-sen University, Guangzhou, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bai-Li","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated\r            Hospital, Sun Yat-sen University, Guangzhou, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated\r            Hospital, Sun Yat-sen University, Guangzhou, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng-Hong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated\r            Hospital, Sun Yat-sen University, Guangzhou, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue-Hua","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Radiology, The First Affiliated Hospital,\r            Sun Yat-sen University, Guangzhou, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated\r            Hospital, Sun Yat-sen University, Guangzhou, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yao","family":"He","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated\r            Hospital, Sun Yat-sen University, Guangzhou, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zi-Ping","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Radiology, The First Affiliated Hospital,\r            Sun Yat-sen University, Guangzhou, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi-Rong","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated\r            Hospital, Sun Yat-sen University, Guangzhou, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rami","family":"Eliakim","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Sheba Medical Center & Sackler School of Medicine, Tel-Aviv University, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shomron","family":"Ben-Horin","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Sheba Medical Center & Sackler School of Medicine, Tel-Aviv University, IsraelDepartment of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min-Hu","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated\r            Hospital, Sun Yat-sen University, Guangzhou, People\u2019s Republic of 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