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Crohn's disease--a diagnostic rarity in Singapore
Insights
This study on Crohn's disease in Singapore found that most patients experienced chronic symptoms and responded well to medical treatments like sulphasalazine and steroids, with a majority achieving long-term remission.
Area of Science:
- Gastroenterology
- Internal Medicine
- Clinical Research
Background:
- Crohn's disease is a chronic inflammatory bowel disease affecting young adults.
- Understanding its presentation and outcomes in diverse populations is crucial for effective management.
Purpose of the Study:
- To describe the clinical characteristics, treatment, and outcomes of Crohn's disease patients in Singapore.
- To analyze the diagnostic criteria and disease sites in this cohort.
Main Methods:
- Retrospective review of nine Crohn's disease cases from Singapore General Hospital (1978-1986).
- Diagnosis confirmed via radiological, endoscopic, operative, and histological assessments.
- Treatment included sulphasalazine, steroids, azathioprine, metronidazole, and surgical intervention in select cases.
Main Results:
- The cohort comprised predominantly young adults with a near-equal male-to-female ratio.
- Common symptoms included abdominal pain, diarrhea, and weight loss, with ileal disease being most frequent.
- Six out of nine patients achieved infrequent or no relapses during follow-up, indicating good long-term outcomes with treatment.
Conclusions:
- Crohn's disease affects a diverse population in Singapore, presenting with varied symptoms and disease locations.
- Medical management, including sulphasalazine and steroids, is effective in achieving long-term remission for a majority of patients.
- Early diagnosis and appropriate treatment strategies are key to managing Crohn's disease and improving patient outcomes.
Abstract:
Nine cases of Crohn's disease from the Department of Medicine, Singapore General Hospital were collected over a duration of 9 years (1978-1986). Male (5): Female (4) ratio was nearly equal. Predominantly young people (mean age 30.5 year, range 12-59 year) from all races in Singapore were affected. Presentation could be acute (1), subacute (2), or chronic (6). The commonest symptoms were abdominal pain (8) diarrhoea (6) and weight loss (6). Three patients had a palpable right iliac fossa mass, 3 had definite malabsorption from ileal disease and 1 had perianal involvement leading to an anal stricture. The only extraintestinal manifestations of disease were clubbing and sacroiliatis. Haematological (haemoglobin, total white count, erythrocyte sedimentation rate) and biochemical (albumin) parameters generally reflected the degree of activity and chronicity of disease prior to presentation. The diagnosis and assessment of disease sites were based on a combination of radiological, endoscopic, operative and histological criteria. Ileal disease (4) per se was commonest followed by ileocolic disease (3) and colonic disease (2). Medical treatment consisted of sulphasalazine +/- steroids in all patients. Azathioprine and metronidazole were used for steroid sparing and perianal disease respectively. Laparotomy was performed in 2 patients. Six patients were well with infrequent (less than or equal to 2 times/year) or no relapses during follow up. Of the remaining three, 2 had either chronically active disease or frequent relapses (greater than 2 times/year) and one severe recurrent disease despite repeated gut resection.