CLINICAL COURSE AND LONG-TERM PROGNOSIS OF CROHNS-DISEASE IN JAPAN

The long-term outcome of Crohn's disease was reviewed in 74 patients who had a history of more than 10 years (range 10.8-27.3) since disease onset. The observation period was between 4.3 and 18.5 years, the mean and SD being 10.6 +/- 3.1 years. The means and SD of age at onset and final observation were 21 +/- 7 and 37 +/- 8 years, respectively. Fifty-eight of the 74 patients had not undergone bowel resection at the time of diagnosis; of these 58, 31 (53.4%) had an operation for the disease during the follow-up period. Thus, of the 74 patients, 47 (63.5%) (these 31, plus the 16 who had undergone bowel resection at the time of diagnosis) had an operation at least once during a follow-up period of 10 years or more. The cumulative operation rates 5, 10, and 15 years after onset in the 74 and 58 patients above were 18.9%, 6.9%, and 40.8%, and 34.8%, 49.1%, and 46.0%, respectively. The corresponding figures 5 and 10 years after diagnosis in all 74 patients and the 58 patients were 32.3% and 28.6% and 47.3% and 46.3%, respectively. There were no significant differences in the incidence of operation rate in relation to anatomical involvement. Cumulative reoperation rates 1, 3, 5, and 10 years after the first operation in the 31 patients who were operated on during the follow-up period were 3.4%, 6.9%, 25.5%, and 51.7%, respectively. Three patients died, the causes of death in one being directly related to Crohn's disease. The cumulative survival rate in all patients was compared with the expected survival rate in a sex- and age-matched general population. There was no significant difference between the two groups in survival rates in the 25-year period since onset. When the degree of satisfaction with quality of life in the previous 1 month and 1 year was evaluated by the patients themselves on an 11-point scale, in which a higher score indicated a better quality of life, about 30% of the patients had scores of 8-10. In the previous 1 year, 53% of the patients had been able to continue the same work, whereas 17% of the patients were not able to work. In conclusion, the prognosis for survival in Crohn's disease was very good; however, about 50% of patients required at least one surgical treatment during the 15-year follow-up period since onset, and about 70% of patients had some bowel or systemic symptoms, or emotional or social problems.