01992 Raven Press, Ltd., New York
J Clin Gastroenterol 1992;15(1):12-6.
Factors Influencing First Relapse in Patients with Crohn’s Disease John P. Wright,
M.B.,
Ch.B.,
Ph.D.
To determine whether information available at time of diagnosis of Crohn’s disease can predict initial clinical course, I followed 239 patients prospectively from time of diagnosis to initial relapse. The patient’s sex, smoking habits, contraceptive usage, disease extent, and presence of granulomas in the first histological specimen were recorded. No association was found between this demographic data and the interval between onset of symptoms and diagnosis, the severity of symptoms at presentation, or the time to relapse. The type of relapse, however, was influenced by the type of the first attack; 70% of relapses were of the same type as the initial attack. Cigarette smoking was associated with ileocolitis (p = 0.028). There was a trend for oral contraceptive users to have ileocolitis, whereas the presence of granulomas in the first histological specimen was not associated with a specific disease distribution. Patients with ileocolitis had more inflammatory attacks than those with ileitis or colitis (p=O.OOl). There was also a trend for cigarette smokers and those on oral contraceptives to have more inflammatory attacks, but the presence of granulomas had no effect on the type of relapse. There i s little to assist in prognosis of early disease when the diagnosis of Crohn’s disease is first made, although the types of attacks tend to repeat themselves. Key Words: Crohn’s disease-Clinical features-prognosis -Recurrences.
Crohn’s disease is a chronic inflammatory disease of the gastrointestinal tract of unknown etiology. Its clinical course is characterized by periods of remission and relapse, with some patients relapsing soon after diagnosis and others being symptom free for prolonged periods. There is not much useful information on the expected clinical course of this protean disease at the time of first diagnosis. Certain factors associated with Crohn’s disease include sex, extent of disease, initial disease severity, cigarette smoking, use of hormonal contraceptives, and the presence of granulomas in histological specimens. To determine whether such information available at time of diagnosis predicts the initial clinical disease course, I prospectively followed a group of patients from time of diagnosis to first relapse. METHODS Patients diagnosed in the Gastrointestinal Clinic of Groote Schuur Hospital between 1970 and 1988 were prospectively followed to determine factors that might predict the early. clinical course and first relapse type. The factors documented included patient sex, extent of disease, use of hormonal contraceptives, cigarette smokTABLE 1. Basic study data No. of patients No. of attacks Mean age 2 SD (yr) M:F Mean follow-up period ? SD (mo) Mean time between onset of symptoms and diagnosis 2 SD (mo) Cigarette smokers: nonsmokers at diagnosis Women using contraceptive hormones: those that did not at diagnosis Extent of disease (% of patients) Ileitis lleocolitis Colitis
From the Gastrointestinal Clinic, Groote Schuur Hospital, and Department of Medicine, University of Cape Town, Cape Town, South Africa. Address correspondence and reprint requests to Professor John P. Wright, Gastrointestinal Clinic, Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa.
12
239 156 31.4 2 12.8 77:162
28.8 ? 31.8 21.2
f
152:82 51:87
89(37) 99(41) 51(22)
36.7
J Clin Gastroenterol 1992;15(1):12-6.
Factors Influencing First Relapse in Patients with Crohn’s Disease John P. Wright,
M.B.,
Ch.B.,
Ph.D.
To determine whether information available at time of diagnosis of Crohn’s disease can predict initial clinical course, I followed 239 patients prospectively from time of diagnosis to initial relapse. The patient’s sex, smoking habits, contraceptive usage, disease extent, and presence of granulomas in the first histological specimen were recorded. No association was found between this demographic data and the interval between onset of symptoms and diagnosis, the severity of symptoms at presentation, or the time to relapse. The type of relapse, however, was influenced by the type of the first attack; 70% of relapses were of the same type as the initial attack. Cigarette smoking was associated with ileocolitis (p = 0.028). There was a trend for oral contraceptive users to have ileocolitis, whereas the presence of granulomas in the first histological specimen was not associated with a specific disease distribution. Patients with ileocolitis had more inflammatory attacks than those with ileitis or colitis (p=O.OOl). There was also a trend for cigarette smokers and those on oral contraceptives to have more inflammatory attacks, but the presence of granulomas had no effect on the type of relapse. There i s little to assist in prognosis of early disease when the diagnosis of Crohn’s disease is first made, although the types of attacks tend to repeat themselves. Key Words: Crohn’s disease-Clinical features-prognosis -Recurrences.
Crohn’s disease is a chronic inflammatory disease of the gastrointestinal tract of unknown etiology. Its clinical course is characterized by periods of remission and relapse, with some patients relapsing soon after diagnosis and others being symptom free for prolonged periods. There is not much useful information on the expected clinical course of this protean disease at the time of first diagnosis. Certain factors associated with Crohn’s disease include sex, extent of disease, initial disease severity, cigarette smoking, use of hormonal contraceptives, and the presence of granulomas in histological specimens. To determine whether such information available at time of diagnosis predicts the initial clinical disease course, I prospectively followed a group of patients from time of diagnosis to first relapse. METHODS Patients diagnosed in the Gastrointestinal Clinic of Groote Schuur Hospital between 1970 and 1988 were prospectively followed to determine factors that might predict the early. clinical course and first relapse type. The factors documented included patient sex, extent of disease, use of hormonal contraceptives, cigarette smokTABLE 1. Basic study data No. of patients No. of attacks Mean age 2 SD (yr) M:F Mean follow-up period ? SD (mo) Mean time between onset of symptoms and diagnosis 2 SD (mo) Cigarette smokers: nonsmokers at diagnosis Women using contraceptive hormones: those that did not at diagnosis Extent of disease (% of patients) Ileitis lleocolitis Colitis
From the Gastrointestinal Clinic, Groote Schuur Hospital, and Department of Medicine, University of Cape Town, Cape Town, South Africa. Address correspondence and reprint requests to Professor John P. Wright, Gastrointestinal Clinic, Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa.
12
239 156 31.4 2 12.8 77:162
28.8 ? 31.8 21.2
f
152:82 51:87
89(37) 99(41) 51(22)
36.7
