Short-term course and prognosis of Crohn's disease

An analysis is presented of the course and outcome of the initial referred attack in a group of 332 patients with Crohn's disease treated at the General Infirmary at Leeds from 1939 to 1968 inclusive. A further 50 cases were excluded on the basis of insufficient diagnostic evidence: usually such patients had acute terminal ileitis. Only 5% of patients achieved full remission on conservative management, and most eventually came to surgery. The overall fatality rate was some 3.3% and this was affected chiefly by the severity of attack and the age of the patient. The severity of attack was classified as mild, moderate, or severe according to a system which took into account factors such as bowel habit, rectal bleeding, abdominal pain, pulse rate, temperature, haemoglobin, and weight. In attacks graded as ;mild', no deaths occurred; in those graded ;severe' the fatality rate was 8.8%. Similarly, whilst no patient under 20 years of age died, the fatality rate in the over 60s was some 14.8%. Further comparison between the present group of 332 patients and an earlier series of 204 patients suffering from ulcerative colitis (Watts, de Dombal, Watkinson, and Goligher, 1966a) shows considerable differences in the course and prognosis of the two diseases. In particular 70% of patients with ulcerative colitis achieved remission on conservative management alone whereas only 5% of Crohn's disease patients did so. These differences, and in particular the poor response to conservative therapy, are discussed, together with their implications for management.