The natural history of fistulizing Crohn's disease in Olmsted County, Minnesota

Gastroenterology. 2002 Apr;122(4):875-80. doi: 10.1053/gast.2002.32362.


Background & aims: Little is known about the cumulative incidence and natural history of fistulas in Crohn's disease in the community.

Methods: The medical records of all Olmsted County, Minnesota residents who were diagnosed with Crohn's disease from 1970 to 1993 and who developed a fistula were abstracted for clinical features and outcomes. Six patients denied research authorization. The cumulative incidence of fistula from time of diagnosis was estimated by using the Kaplan-Meier product-limit method.

Results: At least 1 fistula occurred in 59 patients (35%), including 33 patients (20%) who developed perianal fistulas. Twenty-six (46%) developed a fistula before or at the time of formal diagnosis. Assuming that the 9 patients with fistula before Crohn's disease diagnosis were instead simultaneous diagnoses, the cumulative risk of any fistula was 33% after 10 years and was 50% after 20 years (perianal, 21% after 10 years and 26% after 20 years). At least 1 recurrent fistula occurred in 20 patients (34%). Most fistulizing episodes (83%) required operations, most of which were minor. However, 11 perianal fistulizing episodes (23%) resulted in bowel resection.

Conclusions: Fistulas in Crohn's disease were common in the community. In contrast to referral-based studies, only 34% of patients developed recurrent fistulas. Surgical treatment was frequently required.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Cohort Studies
  • Crohn Disease / epidemiology*
  • Cutaneous Fistula / epidemiology
  • Cutaneous Fistula / surgery
  • Digestive System Fistula / epidemiology*
  • Digestive System Fistula / surgery
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Minnesota / epidemiology
  • Rectal Fistula / epidemiology
  • Rectal Fistula / surgery
  • Rectovaginal Fistula / epidemiology
  • Rectovaginal Fistula / surgery
  • Risk Factors
  • Treatment Outcome