MedWire News: Nearly one in five patients with Crohn's disease will experience penetrating or structuring complications within 90 days of diagnosis, US research suggests.
Within 20 years of diagnosis, half of the patients studied had developed one of these intestinal complications according to the Montreal classification system.
Factors associated with disease progression - including the presence of ileal involvement, upper gastrointestinal involvement, and perianal disease - were present in nearly three-quarters of patients at or shortly after diagnosis.
The researchers say their results "provide clinicians with the tools to prognosticate their patients with regards to intestinal complications, based on the presence of simple baseline clinical factors."
The team studied 306 residents of Olmsted County in Minnesota who were diagnosed with Crohn's disease between 1970 and 2004 and followed-up for a median of 8.4 years. Of these individuals, 56.2% were diagnosed between the ages of 17 and 40 years.
Disease extent was ileal in 45.1%, colonic in 32.0%, and ileocolonic in 18.6%. At baseline, 81.4% had no intestinal complications during the baseline period within 90 days of diagnosis, 4.6% had an intestinal stricture, and 14.1% had developed a penetrating complication, report Edward Loftus Jr (Mayo Clinic, Rochester, Minnesota) and co-workers in the journal Gastroenterology.
The cumulative risk for developing either stricturing or penetrating complications was 18.6% at 90 days, 22.0% at 1 year, 33.7% at 5 years, and 50.8% at 20 years after diagnosis.
Among 249 patients identified with non-stricturing, non-penetrating disease at baseline, 66 had a change in disease behavior (either stricturing or penetrating) within the first 90 days of diagnosis.
Compared with patients who had colonic disease, those with ileal disease alone or ileocolonic Crohn's disease within the first 90 days of diagnosis had a significantly increased risk for developing an intestinal complication in multivariate analysis (hazard ratios=9.25 and 5.74, respectively).
Use of 5-aminosalicylates or sulfasalazine during this baseline period were also associated with an increased risk for an intestinal complication (HR=2.25).
The authors say: "Our results strengthen existing reports that Crohn's disease is a chronic progressive destructive disease, with progression to intestinal complications in many patients."
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