The natural history of fistulizing Crohn's disease in Olmsted County, Minnesota
The natural history of fistulizing Crohn's disease in Olmsted County, Minnesota
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DOI：
10.1053/gast.2002.32362
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发表时间：
2002-04-01
期刊：
影响因子：
29.4
通讯作者：
Sandborn, WJ
中科院分区：
文献类型：
--
作者：
Schwartz, DA;Loftus, EV;Sandborn, WJ
背景与目的：社区对克罗恩病中瘘管的累积发病率和自然史了解甚少。方法：收集1970 - 1993年明尼苏达州奥姆斯特德县所有诊断为克罗恩病并发生瘘管的居民的病历，分析其临床特征和预后。6名患者被拒绝了研究授权。用Kaplan-Meier积限法估计诊断后瘘的累积发生率。结果：59例（35%）患者至少发生1个瘘，其中33例（20%）患者发生肛周瘘。26例（46%）在正式诊断前或确诊时出现了瘘管。假设在克罗恩病诊断前出现瘘的9例患者改为同时诊断，则10年后任何瘘的累积风险为33%，20年后为50%（肛周，10年后为21%，20年后为26%）。20例患者中至少有1例（34%）再次发生瘘管。大多数的拳头发作（83%）需要手术，其中大多数是轻微的。然而，1:1的肛周瘘发作（23%）导致肠切除术。结论：克罗恩病并发瘘管在社区中较为常见。与基于转诊的研究相比，只有34%的患者出现复发性瘘管。经常需要手术治疗。
Background & Aims: Little is known about the cumulative incidence and natural history of fistulas in Crohn's disease in the community. Methods: The medical records of all Olmsted County, Minnesota residents who were diagnosed with Crohn's disease from :1970 to 1993 and who developed a fistula were abstracted for clinical features and outcomes. Six patients denied research authorization. The cumulative incidence of fistula from time of diagnosis was estimated by using the Kaplan-Meier product-limit method. Results: At least 1 fistula occurred in 59 patients (35%), including 33 patients (20%) who developed perianal fistulas. Twenty-six (46%) developed a fistula before or at the time of formal diagnosis. Assuming that the 9 patients with fistula before Crohn's disease diagnosis were instead simultaneous diagnoses, the cumulative risk of any fistula was 33% after 10 years and was 50% after 20 years (perianal, 21% after 10 years and 26% after 20 years). At least :1 recurrent fistula occurred in 20 patients (34%). Most fistulizing episodes (83%) required operations, most of which were minor. However, 1:1 perianal fistulizing episodes (23%) resulted in bowel resection. Conclusions: Fistulas in Crohn's disease were common in the community. In contrast to referral-based studies, only 34% of patients developed recurrent fistulas. Surgical treatment was frequently required.