Progression and prognosis of Crohn's colitis

Z Gastroenterol. 1997 Jan;35(1):7-14.

Abstract

Background: Inflammation refractory to medical treatment frequently characterizes the course of Crohn's colitis, often leading to colectomy and need for a stoma. The influence of disease extent within the colon on prognosis and disease progress over time has not been studied so far.

Aims: We evaluated the disease progress and the long-term outcome in 323 patients with Crohn's colitis followed-up for a mean of 9.8 years.

Methods: The charts were analyzed retrospectively, the mean number of documented examinations was 18.5 per patient. The influence of disease pattern, rectal disease and perianal fistulas on the long-term outcome was evaluated using actuarial methods and independent factor analysis.

Results: The probabilities of having pancolitis or rectal disease were 77.1% and 78.8% after 15 years, respectively, and higher in patients with initially left-sided or segmental colitis compared with right-sided colitis. The chance of having perianal fistulas was 43.3% after 15 years. The risk of undergoing resectional colonic surgery was 62.2% after 15 years and higher in the presence of right-sided colitis. The cumulative risk of colectomy was 18.2% after 15 years and higher in patients with pancolitis, left-sided colitis or in the presence of perianal fistulas. The 15-year probabilities of proctectomy (12%) and of having a temporary stoma (21%) were only influenced by the presence of perianal fistulas but not by rectal disease or pattern of colitis.

Conclusions: Most patients with colonic Crohn's disease will eventually have pancolitis but only 20% of them will loose the colon. The proctectomy rate is low despite a high frequency of rectal disease. Perianal fistulas and the presence of total or left-sided colonic involvement are adverse risk factors with regard to preservation of colonic length.

MeSH terms

  • Adult
  • Colectomy
  • Colon / pathology
  • Colostomy
  • Crohn Disease / diagnosis*
  • Crohn Disease / pathology
  • Crohn Disease / surgery
  • Female
  • Follow-Up Studies
  • Humans
  • Ileostomy
  • Ileum / pathology
  • Male
  • Rectal Fistula / diagnosis
  • Rectal Fistula / pathology
  • Rectal Fistula / surgery
  • Rectum / pathology
  • Treatment Outcome