Factors influencing first relapse in patients with Crohn's disease

Abstract

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 = 0.001). 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 is 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.

PIP: A surgeon followed 239 people diagnosed with Crohn's disease while they were patients at Groote Schuur Hospital in Cape Town, South Africa between 1970 and 1988 until 1st relapse or for 10 years to determine whether risk factors of the disease predicts the clinical disease course. 156 (65%) had suffered from a relapse. The relapse type of about 70% of these cases was of the same type as the 1st attack. Cigarette smokers were more likely to experience ileocolitis than nonsmokers (47% vs. 32%; p=.028). Ileocolitis was linked to an increased number of inflammatory attacks (47% vs. 35% for ileitis and 14% for colitis; p=.001). Thus the researcher concluded that cigarette smoking is linked to Crohn's disease and influences the underlying disease process. A nonsignificant trend existed for combined oral contraceptive use and increased numbers of inflammatory attacks and ileocolitis. Histological granulomas did not effect the relapse pattern of the patients. The Quetelet Index indicated that females were more likely to be malnourished than males (561 vs. 645; p.0001). They presented with more severe Crohn's disease at diagnosis. Obstruction was responsible for 40% of relapses in patients with ileitis. Other than the fact that the type of attack 1st experienced by an individual tends to be the same as the relapse attack, this study did not provide physicians any additional information to help with prognosis of early diagnosis of Crohn's disease.