Crohn's disease: was uncommon.

Clinical bottom line (level 2c)

  1. Crohn's was an uncommon disease. However the incidence has increased.
  2. Up to a third of patients died directly as a consequence of Crohn's disease.
Loftus et al: Gastroenterology 1998; 114 (6): 1161-1168
Expires May 2003

The study

Outcome study with ?objective ?blinded outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: county, USA; 1970-1993

225 patients (aged ?, ?% male) Crohn's disease: diagnosed if two of:
  • clinical history of abdominal pain, weight loss, malaise, diarrhoea and/or rectal bleeding
  • endoscopic findings of mucosal cobblestoning, linear ulceration, skip areas or perianal disease
  • radiological features of strictures, fistula, mucosal cobblestoning or ulceration
  • macroscopic appearance of bowel wall induration, mesenteric lymphadenopathy and 'creeping fat' at laparotomy
  • pathological findings of transmural inflammation and/or epithelioid granulomas


Excluded if
  • resident in county for < 1 year before diagnosis made




    • 100% followed for 0.1 to 51 years (median 13)
    Outcomes studied:
  • mortality
  • mortality due to Crohn's disease

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    mortality 0.1 to 51 years (median 13) 43/225 19%
    (14% to 24%)
    mortality due to Crohn's disease 0.1 to 51 years (median 13) 15/43 35%
    (21% to 49%)

    • prevalence of Crohn's disease: 137 per 100 000 persons
    • incidence of Crohn's disease per 100 000 person-years:
      • 1940-43: 1.0
      • 1944-53: 2.3
      • 1954-63: 3.0
      • 1964-73: 7.8
      • 1974-83: 7.0
      • 1984-93: 6.9
      • total: 5.8
    • No significant differences were noted in the incidence between males and females.

    Citation

    1. Loftus EV, Silverstein MD, Sandborn WJ, et al: Crohn's disease in Olmsted County, Minnesota, 1940-1993: incidence, prevalence and survival. Gastroenterology 1998; 114 (6): 1161-1168
    Contributor: Chris Ball and Clare Wotton, November 2000
    Reviewer:

    Clinical Question.
    Patient Crohn's disease
    Intervention or Exposure prevalence
    Outcome over several decades