Clinical Course in Crohn’s Disease: Results of a Norwegian Population-Based Ten-Year Follow-Up Study

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doi:10.1016/j.cgh.2007.09.002 Copyright © 2007 AGA Institute Published by Elsevier Ltd.

Original article—alimentary tract

Clinical Course in Crohn’s Disease: Results of a Norwegian Population-Based Ten-Year Follow-Up Study

Inger Camilla Solberg, , , Morten H. Vatn‡, Ole Høie§, Njaal Stray, Jostein Sauar¶, Jørgen Jahnsen, Bjørn Moum, Idar Lygren and The IBSEN Study Group ‡Medical Department, Rikshospitalet University Hospital and EpiGen Ahus, Faculty of Medicine, University of Oslo, Oslo, NorwayDepartment of Gastroenterology, Ullevål University Hospital, Oslo, NorwayDepartment of Gastroenterology, Aker University Hospital, Oslo, NorwayDepartment of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway§Department of Internal Medicine, Sørlandet Hospital, Arendal, Norway¶Department of Internal Medicine, Telemark Hospital, Skien, Norway Available online 3 December 2007.

Background & Aims: Most studies concerning the clinical course in CD are retrospective or based on selected patient groups. Our aim was to assess the course of CD in a prospective population-based follow-up study and to identify possible prognostic risk factors for complications on the basis of information obtained at initial diagnosis.

Methods: From 1990–1994, a population-based cohort of 843 new cases of inflammatory bowel disease was recruited in South-Eastern Norway. The cohort was systematically followed up at 1, 5, and 10 years after diagnosis.

Results: Of 237 patients classified as CD, 197 completed the 10 years of follow-up, 18 died, and 22 were lost to follow-up. The cumulative relapse rate during the first 10 years was 90% (95% confidence interval, 86%–94%), and the cumulative probability of surgery was 37.9% (95% confidence interval, 31.4%–44.4%). Terminal ileal location (P < .001), stricturing (P = .004), penetrating behavior (P < .001), and age younger than 40 years (P = .03) at diagnosis were independent risk factors for subsequent surgery. A total of 53% (n = 105) of the patients had developed stricturing or penetrating disease at 10 years. A large proportion of patients (44%) were in clinical remission during the last 5 years of follow-up.

Conclusions: The prognosis for CD seems better than previously reported. The probability of surgery was low, and fewer than expected developed complicated disease behavior. Nevertheless, the cumulative relapse rate of 90% and the finding of prognostic risk factors for subsequent surgery might call for attention to early effective medical treatment strategies.

Abbreviations: CI, confidence interval; IBSEN, Inflammatory Bowel South-Eastern Norway; OR, odds ratio

The following members of the Inflammatory Bowel South-Eastern Norway (IBSEN) Study Group of gastroenterologists are thanked for participating in this study: Magne Henriksen, Østfold Hospital, Moss; Erling Aadland and Tomm Bernklev Aker, University Hospital, Oslo; Stein Dahler, Notodden Hospital, Øystein Kjellevold, Blefjell Hospital, and Finn Strøm, Lovisenberg Diakonale Hospital, Oslo. For help with statistical analysis we thank Milada Småstuen, Department of Biological Statistics, Rikshospitalet University Hospital.Address requests for reprints to: Inger Camilla Solberg, MD, Department of Gastroenterology, Ullevaal University Hospital, Oslo 0407, Norway. fax: +47-22-11-91-81.

Clinical Gastroenterology and Hepatology Volume 5, Issue 12, December 2007, Pages 1430-1438