Inter-Rater Disagreements in Applying the Montreal Classification for Crohn's Disease : The Five-Nations Survey Study
Menchén, Luis (Universidad Complutense de Madrid)
Gutiérrez Casbas, Ana (Hospital General Universitari Dr. Balmis)
Pessarelli, Tommaso (University of Milan)
Correia, Fábio (Hospital Professor Doutor Fernando Fonseca (Portugal))
González Muñoza, Carlos (Institut de Recerca Sant Pau)
López-Cardona, Julia (Hospital Universitario Ramón y Cajal)
Oliveira, Raquel (Unidade Local de Saúde do Algarve)
Favale, Agnese (University of Cagliari (Itàlia))
Calméjane, Louis (Université Paris Cité)
Elosua, Alfonso (Hospital Universitario de Navarra)
Lopes, Sara (Unidade Local de Saúde da Arrábida)
Mauriz, Violeta (Hospital Universitario de Santiago de Compostela)
Tavares de Sousa, Helena (Unidade Local de Saúde do Algarve)
Bertani, Lorenzo (Pontedera Hospital)
Zabana, Yamile (Hospital Universitari Mútua Terrassa (Barcelona))
Serra Ruiz, Xavier (Hospital Universitari Vall d'Hebron)
Viola, Anna (University of Messina)
Barreiro de-Acosta, Manuel (Fundacion Instituto de Investigación Sanitaria de Santiago de Compostela (FIDIS))
Armuzzi, Alessandro (Humanitas University (Itàlia))
Magro, Fernando (Universidade do Porto)
Ukashi, Offir (Tel-Aviv University (Israel))
Amiot, Aurelien (Université Paris Saclay)
Laharie, David (Université de Bordeaux)
Fernandes, Samuel (Grupo de estudos de Doenças Inflamatórias do Intestino (GEDII))
Calabrese. Giulio (University of Naples Federico II)
Ferreiro Iglesias, Rocío (Fundacion Instituto de Investigación Sanitaria de Santiago de Compostela (FIDIS))
Tamir-Degabli, Natalie (Rabin Medical Center)
Konstantine Dussias, Nikolas (University of Bologna)
Mousa, Amjad (Bnai Zion Medical Center)
Richard, Nicolas (Normandie University)
Veisman, Ido (Tel-Aviv University (Israel))
Sharif, Kassem (Tel-Aviv University (Israel))
Ben-Horin, Shomron (Tel-Aviv University (Israel))
Soutullo-Castiñeiras, Carlos (Hospital Universitari i Politècnic La Fe (València))
Dragoni, Gabriele (Careggi University Hospital)
Rotulo, Silvia (Sapienza University of Rome)
Bazin, Thomas (Université de Versailles-Saint-Quentin-en-Yvelines (UVSQ)/Université Paris Saclay)
Felice, Carla (University of Padova (Itàlia))
Coelho Rodrigues, Inês (Clínica Universitária de Gastrenterologia. Faculdade de Medicina de Lisboa)
Jougon, Julia (University of Lille)
Botto, Inês (Clínica Universitária de Gastrenterologia. Faculdade de Medicina de Lisboa)
Ripoll Abadía, Paula (Hospital Universitario y Politécnico La Fe)
De Bernardi, Alice (ASST Rhodense)
Yanai, Henit (Rabin Medical Center (Petah-Tikva, Israel))
Kopylov, Uri (Tel-Aviv University (Israel))
Universitat Autònoma de Barcelona. Departament de Medicina

Fecha:	2025
Resumen:	Background: The Montreal classification has been widely used in Crohn's disease since 2005 to categorize patients by the age of onset (A), disease location (L), behavior (B), and upper gastrointestinal tract and perianal involvement. With evolving management paradigms in Crohn's disease, we aimed to assess the performance of gastroenterologists in applying the Montreal classification. Methods: An online survey was conducted among participants at an international educational conference on inflammatory bowel diseases. Participants classified 20 theoretical Crohn's disease cases using the Montreal classification. Agreement rates with the inflammatory bowel diseases board (three expert gastroenterologists whose consensus rating was considered the gold standard) were calculated for gastroenterologist specialists and fellows/specialists with ≤ 2 years of clinical experience. A majority vote < 75% among participants was considered a notable disagreement. The same cases were classified using three large language models (LLMs), ChatGPT-4, Claude-3, and Gemini-1. 5, and assessed for agreement with the board and gastroenterologists. Fleiss Kappa was used to assess within-group agreement. Results: Thirty-eight participants from five countries completed the survey. In defining the Montreal classification as a whole, specialists (21/38 [55%]) had a higher agreement rate with the board compared to fellows/young specialists (17/38 [45%]) (58% vs. 49%, p = 0. 012) and to LLMs (58% vs. 18%, p < 0. 001). Disease behavior classification was the most challenging, with 76% agreement among specialists and fellows/young specialists and 48% among LLMs compared to the inflammatory bowel diseases board. Regarding disease behavior, within-group agreement was moderate (specialists: k = 0. 522, fellows/young specialists: k = 0. 532, LLMs: k = 0. 577; p < 0. 001 for all). Notable points of disagreement included: defining disease behavior concerning obstructive symptoms, assessing disease extent via video capsule endoscopy, and evaluating treatment-related reversibility of the disease phenotype. Conclusions: There is significant inter-rater disagreement in applying the Montreal classification, particularly for disease behavior in Crohn's disease. Improved education or revisions to phenotype criteria may be needed to enhance consensus on the Montreal classification.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Crohn's disease ; complicated disease phenotype ; inflammatory bowel diseases ; large language models ; montreal classification
Publicado en:	United European Gastroenterology journal, Vol. 13, Num. 5 (June 2025) , p. 685-696, ISSN 2050-6414

DOI: 10.1002/ueg2.12757
PMID: 39825768

12 p, 603.6 KB

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