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Inter rater disagreements in applying the montreal classification for Crohn's disease: the five nations survey study

2025-01-18Journal article Open access
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dc.contributor.authorUkashi, Offir
dc.contributor.authorAmiot, Aurelien
dc.contributor.authorLaharie, David
dc.contributor.authorMenchén, Luis
dc.contributor.authorGutiérrez, Ana
dc.contributor.authorFernandes, Samuel
dc.contributor.authorPessarelli, Tommaso
dc.contributor.authorCorreia, Fábio
dc.contributor.authorGonzalez‐Muñoza, Carlos
dc.contributor.authorLópez‐Cardona, Julia
dc.contributor.authorCalabrese, Giulio
dc.contributor.authorFerreiro‐Iglesias, Rocio
dc.contributor.authorDegabli, Natalie Tamir
dc.contributor.authorDussias, Nikolas Konstantine
dc.contributor.authorMousa, Amjad
dc.contributor.authorOliveira, Raquel
dc.contributor.authorRichard, Nicolas
dc.contributor.authorVeisman, Ido
dc.contributor.authorSharif, Kassem
dc.contributor.authorBen‐Horin, Shomron
dc.contributor.authorSoutullo‐Castiñeiras, Carlos
dc.contributor.authorDragoni, Gabriele
dc.contributor.authorRotulo, Silvia
dc.contributor.authorFavale, Agnese
dc.contributor.authorCalméjane, Louis
dc.contributor.authorBazin, Thomas
dc.contributor.authorElosua, Alfonso
dc.contributor.authorLopes, Sara
dc.contributor.authorFelice, Carla
dc.contributor.authorMauriz, Violeta
dc.contributor.authorRodrigues, Inês Coelho
dc.contributor.authorJougon, Julia
dc.contributor.authorBotto, Inês
dc.contributor.authorSousa, Helena Tavares de
dc.contributor.authorBertani, Lorenzo
dc.contributor.authorAbadía, Paula Ripoll
dc.contributor.authorDe Bernardi, Alice
dc.contributor.authorZabana, Yamile
dc.contributor.authorSerra‐Ruiz, Xavier
dc.contributor.authorViola, Anna
dc.contributor.authorAcosta, Manuel Barreiro de
dc.contributor.authorYanai, Henit
dc.contributor.authorArmuzzi, Alessandro
dc.contributor.authorMagro, Fernando
dc.contributor.authorKopylov, Uri
dc.date.accessioned2025-03-10T10:00:03Z
dc.date.available2025-03-10T10:00:03Z
dc.date.issued2025-01-18
dc.description.abstractBackground: 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 phenotypeeng
dc.identifier.doi10.1002/ueg2.12757
dc.identifier.eissn2050-6414
dc.identifier.issn2050-6406
dc.identifier.urihttp://hdl.handle.net/10400.1/26880
dc.language.isoeng
dc.peerreviewedyes
dc.publisherWiley
dc.relation.hasversionhttps://onlinelibrary.wiley.com/doi/10.1002/ueg2.12757
dc.relation.ispartofUnited European Gastroenterology Journal
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectCrohn's disease
dc.subjectComplicated disease phenotype
dc.subjectInflammatory bowel diseases
dc.subjectLarge language models
dc.subjectMontreal classification
dc.titleInter rater disagreements in applying the montreal classification for Crohn's disease: the five nations survey studyeng
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage12
oaire.citation.startPage1
oaire.citation.titleUnited European Gastroenterology Journal
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85

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