Clinical—Alimentary TractRisk Factors Associated With Progression to Intestinal Complications of Crohn's Disease in a Population-Based Cohort
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.)
References (36)
- et al.
Clinical course in Crohn's disease: results of a Norwegian population-based ten-year follow-up study
Clin Gastroenterol Hepatol
(2007) - et al.
Scheduled maintenance treatment with infliximab is superior to episodic treatment for the healing of mucosal ulceration associated with Crohn's disease
Gastrointest Endosc
(2006) - et al.
Effects of adalimumab therapy on incidence of hospitalization and surgery in Crohn's disease: results from the CHARM study
Gastroenterology
(2008) - et al.
Infliximab maintenance treatment reduces hospitalizations, surgeries, and procedures in fistulizing Crohn's disease
Gastroenterology
(2005) - et al.
Early combined immunosuppression or conventional management in patients with newly diagnosed Crohn's disease: an open randomised trial
Lancet
(2008) - et al.
The natural history of corticosteroid therapy for inflammatory bowel disease: a population-based study
Gastroenterology
(2001) - et al.
The natural history of fistulizing Crohn's disease in Olmsted County, Minnesota
Gastroenterology
(2002) History of the Rochester Epidemiology Project
Mayo Clin Proc
(1996)- et al.
Crohn's disease in Olmsted County, Minnesota, 1940–1993: incidence, prevalence, and survival
Gastroenterology
(1998) Clinical epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental influences
Gastroenterology
(2004)
Inflammatory bowel disease: clinical aspects and established and evolving therapies
Lancet
Are perineal and luminal fistulas associated in Crohn's disease?A population-based study
Clin Gastroenterol Hepatol
Predictors of Crohn's disease
Gastroenterology
Effects of cigarette smoking on the long-term course of Crohn's disease
Gastroenterology
A simple classification of Crohn's disease: report of the Working Party for the World Congresses of Gastroenterology, Vienna 1998
Inflamm Bowel Dis
Changes in Crohn's disease phenotype over time in the Chinese population: validation of the Montreal classification system
Inflamm Bowel Dis
Long-term evolution of disease behavior of Crohn's disease
Inflamm Bowel Dis
Natural history and clinical behavior of Crohn's disease extending beyond two decades
J Clin Gastroenterol
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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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