Gastroenterology

Gastroenterology

Volume 139, Issue 4, October 2010, Pages 1147-1155
Gastroenterology

Clinical—Alimentary Tract
Risk Factors Associated With Progression to Intestinal Complications of Crohn's Disease in a Population-Based Cohort

https://doi.org/10.1053/j.gastro.2010.06.070Get rights and content

Background And Aims

We sought to assess the evolution of Crohn's disease behavior in an American population-based cohort.

Methods

Medical records of all Olmsted County, Minnesota residents who were diagnosed with Crohn's disease from 1970 to 2004 were evaluated for their initial clinical phenotype, based on the Montreal Classification. The cumulative probabilities of developing structuring and/or penetrating complications were estimated using the Kaplan-Meier method. Proportional hazards regression was used to assess associations between baseline risk factors and changes in behavior.

Results

Among 306 patients, 56.2% were diagnosed between the ages of 17 and 40 years. Disease extent was ileal in 45.1%, colonic in 32.0%, and ileocolonic in 18.6%. At baseline, 81.4% had nonstricturing nonpenetrating disease, 4.6% had stricturing disease, and 14.0% had penetrating disease. The cumulative risk of developing either complication was 18.6% at 90 days, 22.0% at 1 year, 33.7% at 5 years, and 50.8% at 20 years after diagnosis. Among 249 patients with nonstricturing, nonpenetrating disease at baseline, 66 changed their behavior after the first 90 days from diagnosis. Relative to colonic extent, ileal, ileocolonic, and upper GI extent were significantly associated with changes in behavior, whereas the association with perianal disease was barely significant.

Conclusions

In a population-based cohort study, 18.6% of patients with Crohn's disease experienced penetrating or stricturing complications within 90 days after diagnosis; 50% experienced intestinal complications 20 years after diagnosis. Factors associated with development of complications were the presence of ileal involvement and perianal disease.

Section snippets

Study Setting and Patients

Olmsted County, situated in southeastern Minnesota, had a population of 124,277 inhabitants in the 2000 US Census. The majority of people reside in Rochester, the urban center of an otherwise rural county. In the 2000 census, 89% of residents were non-Hispanic white, and a substantial portion was of northern European heritage. Although 25% of county residents are employed in health care services (vs 8% nationwide), and the level of education is consequently higher (30% of adults have completed

Baseline Characteristics

Three hundred and six Crohn's disease patients were followed for a total of 3013 person-years, with a median follow-up duration of 8.4 years (range, 2 days to 35.9 years). One hundred and fifty patients (49%) were male (Table 1). Median age at Crohn's disease diagnosis was 30.2 years (range, 8.4–91.4 years). Perianal disease had been identified before Crohn's disease diagnosis in 15 patients (4.9%), and within the first 90 days of diagnosis in an additional 36 (11.8%). Among the 15 patients

Discussion

In this population-based study on the evolution of Crohn's disease, almost 19% of patients had already experienced penetrating or stricturing complications within the first 90 days of diagnosis, and fully half of all patients had experienced an intestinal complication 20 years after diagnosis. Among those with nonstricturing and nonpenetrating disease at baseline with progression to an intestinal complication, 76.7% of patients required bowel resection surgery within 6 months of the event.

Acknowledgments

Presented in part at the 73rd Annual Meeting of the American College of Gastroenterology, Orlando, Florida, October 3–8, 2008. (Thia K, Sandborn W, Harmsen W, Zinsmeister A, Loftus E. The Evolution of Crohn's Disease (CD) Behavior in a Population-based Cohort. Am J Gastroenterol 2008;103(Suppl S):S443–S444.)

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    This article has an accompanying continuing medical education activity on page e13. Learning Objective: Upon completion of reading this article, successful learners will be able to evaluate the cumulative risk of intestinal complications among patients with Crohn's disease and to assess clinical factors at baseline associated with the development of complications.

    Conflicts of interest The authors disclose no conflicts.

    Funding Supported in part by Mayo Foundation for Medical Education and Research; and made possible by the Rochester Epidemiology Project (AR030582 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases).

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