Progression and prognosis of Crohn's colitis

Inflammation refractory to medical treatment frequently characterizes the course of Crohn's colitis, often leading to colectomy and need for a stoma. The influence of disease extent within the colon on prognosis and disease progress over time has not been studied so far.

We evaluated the disease progress and the long-term outcome in 323 patients with Crohn's colitis followed-up for a mean of 9.8 years.

The charts were analyzed retrospectively, the mean number of documented examinations was 18.5 per patient. The influence of disease pattern, rectal disease and perianal fistulas on the long-term outcome was evaluated using actuarial methods and independent factor analysis.

The probabilities of having pancolitis or rectal disease were 77.1% and 78.8% after 15 years, respectively, and higher in patients with initially left-sided or segmental colitis compared with right-sided colitis. The chance of having perianal fistulas was 43.3% after 15 years. The risk of undergoing resectional colonic surgery was 62.2% after 15 years and higher in the presence of right-sided colitis. The cumulative risk of colectomy was 18.2% after 15 years and higher in patients with pancolitis, left-sided colitis or in the presence of perianal fistulas. The 15-year probabilities of proctectomy (12%) and of having a temporary stoma (21%) were only influenced by the presence of perianal fistulas but not by rectal disease or pattern of colitis.

Most patients with colonic Crohn's disease will eventually have pancolitis but only 20% of them will loose the colon. The proctectomy rate is low despite a high frequency of rectal disease. Perianal fistulas and the presence of total or left-sided colonic involvement are adverse risk factors with regard to preservation of colonic length.