Gastroenterology  1985 Jun;88(6):1818-25 

Long-term follow-up of patients with Crohn's disease. Relationship between the

clinical pattern and prognosis.

Farmer RG, Whelan G, Fazio VW.

In a study of 615 new patients with Crohn's disease consecutively diagnosed at

the Cleveland Clinic between 1966 and 1969, 592 patients were observed (mean

greater than 13 yr, minimum 7 yr), giving a follow-up rate of 96.3%. The

original hypothesis was that initial anatomic involvement (the clinical pattern)

bears directly on clinical course and prognosis. Disease sites were as follows:

246 ileocolic, 165 small intestine, and 181 colon/anorectal. Among patients with

ileocolic disease, 225 (91.5%) had surgery. For the small intestine pattern, the

operative incidence was 65.5%; for the colon/anorectal pattern, it was 58%.

Operations were for specific reasons: internal fistula with abscess or

intestinal obstruction for ileocolic pattern; intestinal obstruction for small

intestine pattern; and severe perianal disease or toxic megacolon for

colon/anorectal pattern. Complications among nonoperated patients included

perianal fistulas and extraintestinal manifestations. No statistical correlation

existed between type and duration of medical treatment and prognosis.

Seventy-five deaths occurred (12.8%), 36 of which related directly to Crohn's

disease. Even after many years, symptoms continued and quality of life tended to

be suboptimal among operated patients. For nonoperated patients, the most

favorable quality of life was experienced by those with segmental involvement of

the colon or ileum. Poor prognosis correlated with ileocolic disease and

presence of sepsis because of an internal fistula.