Long-term complications, extraintestinal manifestations, and mortality in adult Crohn's disease in population-based cohorts
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Laurent Peyrin-Biroulet1, Edward V Loftus, Jean-Frederic Colombel
1Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Insights
Crohn's disease (CD) patients face increased risks of fractures, blood clots, cancers, and other conditions. Long-term complications and mortality are slightly elevated in adults with CD.
Area of Science:
- Gastroenterology
- Immunology
- Epidemiology
Background:
- Crohn's disease (CD) is a chronic, inflammatory condition with diverse intestinal and extraintestinal complications.
- Understanding long-term outcomes and mortality in CD is crucial for patient management.
Purpose of the Study:
- To review population-based studies on long-term complications, extraintestinal manifestations, and mortality in adult Crohn's disease patients.
- To summarize current knowledge regarding the risks associated with CD.
Main Methods:
- A comprehensive literature search was conducted using Medline (PubMed) for English and non-English publications.
- The search covered studies published from 1935 to July 2009, focusing on long-term follow-up data.
Main Results:
- CD patients exhibit a 30-40% increased risk of fractures and a 3-fold higher risk of deep venous thrombosis and pulmonary embolism.
- Associated conditions include primary sclerosing cholangitis, ankylosing spondylitis, various cancers (colorectal, small bowel, lymphoma), and increased overall mortality (SMR 1.4).
- Numerous extraintestinal manifestations and associated diseases were identified.
Conclusions:
- Crohn's disease is frequently linked to significant complications and extraintestinal conditions.
- The long-term impact of evolving treatments, including immunosuppressives and biologics, on disease complications remains uncertain.
Background:
Crohn's disease (CD) is a chronic, progressive, destructive disease. Numerous intestinal and extraintestinal complications and manifestations can occur during its clinical course. This literature review summarizes our current knowledge of the long-term complications, extraintestinal complications, and mortality in CD in adults as reported in population-based studies that include long-term follow-up results.
Methods:
A literature search of English and non-English language publications listed in the electronic databases of Medline (source PubMed, 1935 to July, 2009).
Results:
The relative risk of incident fractures is increased in CD patients by ≈30%-40%. These patients have also have a 3-fold increased risk of deep venous thrombosis and pulmonary embolism. A variety of extraintestinal manifestations (primary sclerosing cholangitis, ankylosing spondylitis, iritis/uveitis, pyoderma gangrenosum, erythema nodosum) and diseases (asthma, bronchitis, pericarditis, psoriasis, rheumatoid arthritis, and multiple sclerosis) are associated with CD. The risks of colorectal and small bowel cancers relative to the general population are 1.4-1.9 and 21.1-27.1, respectively. A slightly increased risk of lymphoma, irrespective of medication use, has been reported in a recent meta-analysis of population-based studies. Overall mortality is slightly increased in CD, with a standardized mortality ratio of 1.4.
Conclusions:
CD is frequently associated with disease complications and extraintestinal conditions. Whether the impact of changing treatment paradigms with increased use of immunosuppressives and biologic agents can reduce disease complications and associated conditions is unknown.
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