Prognosis

Crohn's disease (CD) is a chronic disease with variable frequency of relapses and multiple possible complications. However, appropriate medical and surgical management may enable patients to have a reasonable quality of life.

Natural history

Typically patients with CD have intermittent exacerbations followed by periods of remission, with 10% to 20% of patients experiencing a prolonged remission after the initial presentation.[111][275][276]

Many patients with CD require surgical treatment for the complications of their disease. The use of immunomodulators and biological therapies reduces the risk of surgery and hospitalisation in patients with CD.[277]

Patients with isolated ileocolonic disease are likely to undergo surgery, with some studies reporting up to 90% having surgery by 10 years. Of these people, 50% will never require further surgery.[278] Up to one third of patients with gastroduodenal CD require gastrojejunostomy bypass for obstruction.[279]

Predictors of a relatively severe disease include age <40 years at diagnosis, the presence of perianal disease, and initial requirement for corticosteroids.[280]

Mortality

CD is associated with a decrease in life expectancy. The mortality rate of patients with CD increases with the duration of the disease, higher comorbidity score, lower socioeconomic status, and in the 30 days post gastrointestinal surgery. One European population-based cohort study of the natural course of CD (that included 488 patients followed prospectively from time of diagnosis) reported 16 (3%) deaths during follow-up at a median 25 months.[277]

Colon cancer is the leading cause of disease-related death, and other causes include non-Hodgkin's lymphoma, digestive diseases, pulmonary embolism, and sepsis.[281][282][283][284]

Use of this content is subject to our disclaimer