Clinical Course in Crohn's Disease: Results of a Norwegian Population-Based Ten-Year Follow-Up Study

Clin Gastroenterol Hepatol. 2007 Dec;5(12):1430-8. doi: 10.1016/j.cgh.2007.09.002.

Abstract

Background & aims: Most studies concerning the clinical course in CD are retrospective or based on selected patient groups. Our aim was to assess the course of CD in a prospective population-based follow-up study and to identify possible prognostic risk factors for complications on the basis of information obtained at initial diagnosis.

Methods: From 1990-1994, a population-based cohort of 843 new cases of inflammatory bowel disease was recruited in South-Eastern Norway. The cohort was systematically followed up at 1, 5, and 10 years after diagnosis.

Results: Of 237 patients classified as CD, 197 completed the 10 years of follow-up, 18 died, and 22 were lost to follow-up. The cumulative relapse rate during the first 10 years was 90% (95% confidence interval, 86%-94%), and the cumulative probability of surgery was 37.9% (95% confidence interval, 31.4%-44.4%). Terminal ileal location (P < .001), stricturing (P = .004), penetrating behavior (P < .001), and age younger than 40 years (P = .03) at diagnosis were independent risk factors for subsequent surgery. A total of 53% (n = 105) of the patients had developed stricturing or penetrating disease at 10 years. A large proportion of patients (44%) were in clinical remission during the last 5 years of follow-up.

Conclusions: The prognosis for CD seems better than previously reported. The probability of surgery was low, and fewer than expected developed complicated disease behavior. Nevertheless, the cumulative relapse rate of 90% and the finding of prognostic risk factors for subsequent surgery might call for attention to early effective medical treatment strategies.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Adult
  • Confidence Intervals
  • Crohn Disease / diagnosis*
  • Crohn Disease / epidemiology
  • Crohn Disease / therapy
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Norway / epidemiology
  • Odds Ratio
  • Prevalence
  • Prognosis
  • Recurrence
  • Retrospective Studies
  • Risk Factors
  • Time Factors