Clinical profile and predictors of disease behavior and surgery in Indian patients with Crohn's disease

Abstract

Background: Recent years have seen the emergence of Crohn's disease (CD) in India and the predictors of disease behavior and surgery in these patients are not known.

Methods: The demographic and clinical profiles of patients diagnosed to have CD from January 1995 to December 2008 were analyzed retrospectively and associations with disease behavior and surgery were determined using multivariate analysis.

Results: Two hundred and twenty-three patients (age 35 ± 14.7 years, males 57.9 %) were included. Extraintestinal manifestations were noted in 27.4 % patients. There was a median delay of 24 months to diagnosis; 66 (29.6 %) patients received antitubercular therapy prior to diagnosis. The most common site of involvement was ileocolonic (40.4 %), and the most common disease behavior was nonstricturing and nonpenetrating (57.8 %). The disease was moderate to severe in 79 %. Around 40 % patients had a relapsing course of illness. Seventy-three patients (32.7 %) had at least one surgical intervention. Independent associations with aggressive disease behavior included the presence of small bowel disease and longer duration of illness. Predictors of surgical intervention were male sex, small bowel disease, perianal disease, and aggressive disease behavior.

Conclusion: Diagnosis of CD is still delayed in India. Longer duration of illness predicted aggressive disease behavior. Surgery was performed more often in males with aggressive disease involving the small bowel and perianal area.