Natural History and Clinical Behavior of Crohn's Disease Extending Beyond Two Decades

Abstract

Crohn's disease is a heterogeneous inflammatory disorder characterized by strictures or perforating complications. Information on natural history is limited. In the present study, 150 patients with long-standing Crohn's disease, including 81 females and 69 males, were seen continuously by a single clinician for at least 20 years. Additional retrospective data were available extending for >40 years and 13 have now died, usually with an advanced malignancy. To evaluate disease expression, phenotypic clinical characteristics defined by the 1998 Vienna classification for Crohn's disease were used and included age at diagnosis, location of disease, and disease behavior at the time of diagnosis or 10 years or 20 years after diagnosis. Most patients were initially diagnosed before the age of 40 years (94%) and had ileocolonic disease (65.3%). At diagnosis, both females and males were most often classified with inflammatory disease (nonstenosing, nonpenetrating); however, over the course of the disease, particularly in the first decade, decreased numbers of patients with inflammatory disease and increased numbers with penetrating disease were seen. In addition, some with stenosing disease eventually developed penetrating disease. Disease localized to ileum alone was most often complicated by stricture formation, whereas ileocolonic disease was usually complicated by a penetrating complication. This shift in disease behavior indicates that Crohn's disease is a dynamic process that phenotypically evolves and progresses with time.

Association between disease duration and usefulness of fecal calprotectin measurement in patients with Crohn’s disease

“…However, large epidemiological studies have confirmed that a substantial proportion of patients tends to progress to a disabling form of CD. 4,6,14 It has been shown that more than a half of the patients with CD develop stricturing or penetrating complications or both within a mean time of 10 years. 13-16 Therefore, we divided our study group into 2 subgroups depending on disease duration from diagnosis.…”

“…It was shown that after 10 years, half of the CD patients required surgery because of the intestinal complications of the disease. 6 The measurement of fecal calprotectin levels is believed to be one of the most accurate tools for the estimation of CD activity. It correlates with biochemical findings and endoscopic severity of the disease.…”

Long-term natural history of Crohn’s disease

“…It also seems progressive, although the rate of progression may be altered or slowed, by the use of some therapy, such as steroids, antibiotics, or resective surgery, at least for a period of time. It appears that the disease begins as an inflammatory process that progressively develops over time to a more complex disease with stricture and fistula formation [11][12][13] . Once initiated, it is likely that numerous genetic and environmental factors play a role in regulating the rate of progression, but these are poorly understood.…”

Using of magnetic resonance enterography in the management of Crohn's disease of the small intestine: First year of experience

“…CD lesions are highly variable; ulceration of the mucosa, oedema and thickening of the intestinal wall, fistulas, fibrotic stenosis, peritoneal lymphadenopathy and involvement of the mesenteric fat (1). Therefore, endoscopic and radiologic studies are necessary in order to properly characterise its extent and the intraluminal and extraluminal changes that are seen in CD.…”