Wolfson Medical Center, Tel Aviv University, Israel.
Inflamm Bowel Dis. 2011 Jun;17(6):1314-21. doi: 10.1002/ibd.21493. Epub 2010 Nov 8.
Crohn's disease and ulcerative colitis are complex disorders with some shared and many unique predisposing genes. Accurate phenotype classification is essential in determining the utility of genotype-phenotype correlation. The Montreal Classification of IBD has several weaknesses with respect to classification of children. 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.
Focusing on facilitating research in pediatric inflammatory bowel disease (IBD), and creating uniform standards for defining IBD phenotypes, an international group of pediatric IBD experts met in Paris, France to develop evidence-based consensus recommendations for a pediatric modification of the Montreal criteria.
Important modifications 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 L4a (proximal to ligament of Treitz) and L4b (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 G(1) versus G(0) (never growth failure), adding E4 to denote extent of ulcerative colitis that is proximal to the hepatic flexure, and denoting ever severe ulcerative colitis during disease course by S1.
These modifications are termed the Paris Classification. By adhering to the Montreal framework, we have not jeopardized or altered the ability to use this classification for adult onset disease or by adult gastroenterologists.
克罗恩病和溃疡性结肠炎是具有一些共同和许多独特易患基因的复杂疾病。准确的表型分类对于确定基因型-表型相关性的实用性至关重要。蒙特利尔 IBD 分类法在儿童分类方面存在一些弱点。目前的蒙特利尔分类法没有充分捕捉儿科疾病表型的动态特征（疾病位置和行为随时间的变化，生长障碍）。
为了促进儿科炎症性肠病（IBD）的研究，并为 IBD 表型定义统一标准，一组国际儿科 IBD 专家在法国巴黎开会，制定了基于证据的共识建议，对蒙特利尔标准进行儿科修正。
制定的重要修正包括将诊断时的年龄分类为 A1a（0 至<10 岁）、A1b（10 至<17 岁）、A2（17 至 40 岁）和 A3（>40 岁），将远端回肠以上的疾病分类为 L4a（Treitz 韧带上方）和 L4b（Treitz 韧带至远端回肠上方），允许同一患者同时存在狭窄和穿透性疾病（B2B3），表示患者在任何时候都存在生长障碍为 G(1)与 G(0)（从未有生长障碍），增加 E4 表示溃疡性结肠炎近端到肝曲的程度，并表示疾病过程中始终存在严重溃疡性结肠炎为 S1。
这些修正被称为巴黎分类法。通过坚持蒙特利尔框架，我们既没有危及也没有改变该分类方法用于成人发病疾病或成人胃肠病学家的能力。
