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Crohn’s disease (CD) is a chronic inflammatory gastrointestinal (GI) disorder characterized by a progressive course, resulting in irreversible bowel damage. The ultimate goal of medical therapy in CD would be changing its natural disease course and preventing further progression, bowel damages and disabilities. Therefore, it is important to understand what prognostic factors are associated with CD related complications, who is at the risk of aggressive CD requiring more earlier and aggressive therapies than others. Previous Western studies have shown that jejunal involvement of CD is associated with the higher risk of stricturing and penetrating complications, surgery, and postoperative recurrence. In addition, younger age at initial diagnosis, the presence of perianal disease, the need for systemic steroid therapies, smoking, and any significant change of serologic markers have been suggested as predictors of its aggressive disease activity. However, there only have been limited studies for these issues preformed in Korean CD patients. Moreover, CD phenotypes seem to differ considerably between East Asians and whites. Korean CD patients revealed a male predominance in sex distribution, predominance of ileocolonic disease in the disease location, and a higher incidence of perianal fistula in disease behavior. Therefore it is important to be aware of the subtypes and natural history of CD and the medication used to treat the disease in order to optimize the health care of patients with CD in different populations. In this issue of Gut and Liver, the article “The clinical characteristics and prognosis of Crohn’s disease in Korean patients showing proximal small bowel involvement: results from the CONNECT study” by Kim et al. performed a nation-wide cohort study including 1,329 CD patient from 32 Korean institutions. The result showed that the patients with jejunal involvement were more likely to be smokers (18.9% vs 14.2%), having less frequent L2 (colonic) disease (2.7% vs 19.2%) and fewer perianal fistulas at diagnosis (20.7% vs 28.3%), and displaying more complicated (stricturing) disease behavior (19.8% vs 12.7%) compared to those without jejunal involvement. Considering surgery-free survival of patients, the patients with jejunal involvement showed significantly lower 10 year surgery-free survival rate than those without jejunal involvement (58.4% vs 67.8%, p<0.001). After adjusting for possible confounding variables, such as age, sex, and perianal fistulas, jejunal involvement was found to be an independent risk factor for surgery after CD diagnosis (hazard ratio [HR], 1.524; 95% confidence interval, 1.184 to 1.961). In addition to jejunal involvement, female sex and complicated disease behavior were poor prognostic factors in terms of surgery-free survival (HR: female sex, 1.307; structuring behavior, 1.356; penetrating behavior, 2.131). Therefore, authors concluded that proximal small bowel involvement should be evaluated in patients with CD for predicting long-term clinical outcomes. They also suggested that if aggressive medical therapy is provided to patients with complicated disease behavior, also the patients with jejunal involvement should be actively considered for those treatments. The present study is very meaningful because it is the first multicenter nation-wide cohort data providing better understandings of clinical characteristics and prognosis of Korean CD patients with jejunal involvement. The incidence of jejunal in-

Crohn's Disease with Jejunal Involvement as a Predictor of Long-Term Clinical Outcomes