Long-term Clinical Course and Prognosis of Patients with Crohn's Disease Fumihito Hirai 1 , Noritaka Takatsu 1 , Kazeo Ninomiya 1 , Takanori Baba 1 , Takao Kanemitsu 1 , Tsuyoshi Morokuma 1 , Yoshihiko Karashima 1 , Kensei Ootsu 1 , Ryohei Minoda 1 , Masayoshi Miyaoka 1 , Shinichirou Maki 1 , Yuji Murakami 1 , Takahiro Beppu 1 , Masao Takeichi 1 , Taku Nishimura 1 , Sumio Tsuda 1 , Toshiyuki Matsui 1 , Kitaro Futami 2 , Akinori Iwashita 3 1Department of Gastroenterology, Chikushi Hospital, Fukuoka University, Chikushino, Japan 2Department of Surgery, Chikushi Hospital, Fukuoka University, Chikushino, Japan 3Department of Pathology, Chikushi Hospital, Fukuoka University, Chikushino, Japan Keyword: Crohn病 , 長期経過 , 長期予後 , 経過良好例 , 予後予測 pp.1843-1858
Published Date 2007/12/25
DOI https://doi.org/10.11477/mf.1403101239
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 The aim of this study is to clarify long-term clinical course, prognosis and prognostic factors of patients with Crohn's disease (CD). 221 patients with CD whose clinical course had continued for 15 years after onset were studied. For an analysis without bias, not only those patients currently under observation at our hospital (the follow-up groups), but also those not being observed (non-follow-up group) were investigated as for a possible. We classified these patients into two prognosis groups (good, bad) according to the evaluation of their whole clinical course. We evaluated their clinical course and prognosis mainly based on the contents of the individual clinical survey sheet that was designed by the Ministry of Health, Labor and Welfarefor. In addition, to clarify the factors influencing the prognosis of patients with CD, we compared the clinical backgrounds of these two groups', including disease type, laboratory data, disease activity indices, radiographic and endoscopic findings at the time of diagnosis. Among the 221 patients, 187 (84.6%) were able to be observed during their clinical course. 53 patients (28.3%) were in the good prognosis group and 104 patients (71.7%) were in the bad prognosis group. According to analysis of comparisons between the two groups, the age of onset of the bad prognosis group was significantly younger than that of the good prognosis group. For disease types, ileo-colitis type was dominant in the bad prognosis group and aphthous type and colitis type were frequent findings in the good one. Both activity indices, IOIBD and CDAI, were significantly higher in the bad group, suggesting that the conditions at the early stage of the disease are the factors affecting the clinical course and prognosis. In the evaluation by radiographic and endoscopic findings, the following were suspected to be involved in the clinical course and prognosis:the presence and extent of the lesions involving the jejunum and upper ileum;and the severity of longitudinal ulcers of the small intestine and the severity of cobblestone appearance of both the small and large intestine. These findings indicated that the results of a long-term clinical observation and prognosis are satisfactory in approximately 30% of the cases with CD in Japan. We also speculated that young age, disease type, activity indices and morphological findings at diagnosis are able to be predictive factors of the clinical course and prognosis of patients with CD, but larger numbers and multi-center studies are necessary to verify these results.

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