The Long-term Outcome in Crohn's Disease P.H. HARPER, M.CH., F.R.C.S., V.W. FAZlO, M.B., B.S., F.R.A.C.S., I.C. LAVERY,M.B., B.S., F.R.A.C.S., D.G. JAGELMAN, M.S., F.R.C.S., F.L. WEAKLEY,M.D., R.G. FARMER, M.D., K.A. EASLEY, M.S. Harper PH, FazioVW, Lavery IC, Jagelman DG, Weakley FL, Farmer RG, EasleyKA. The long-term outcome in Crohn's disease. Dis Colon Rectum 1987;30:174-179. The long-term outcome of Crohn's disease was reviewedin 139patients who were treated at the ClevelandClinic for a minimum of 15 years. At the time of diagnosis, 38 (27percent), 39 (28percent) and 62(43percent) patients had small-bowel, large-bowel, and ileocolic patterns of dis- ease, respectively. The disease progressed with time and, eventually, 104 (75 percent) patients had ileocolic disease. One hundred twenty- two patients (88percent) underwent at least one definitive operation for the disease. Forty-four (32percent)patients had proctocolectomies and 65 (47 percent) have ileostomies. Associatedmanifestationsof Crohn's disease occurred in a high proportion ofpatients; perianal disease in 78 (56percent), intestinal fistulas in 45 (32percent), extraintestinal disease in 49 (35 percent). Six patients died of causes directly related to the disease. Specific complications tend to occur at definite times in the course of the disease. Crohn's disease is not a benign condition. There is a relentless progression of the disease and a high incidence of complica- tions when patients are followed over a long period. [Key words: Crohn's disease, Long-term outcome; Complications] CROHN'S DISEASE is a chronic condition commonly presenting in young patients. The long-term effects of the disease, however, are not well recorded. There are only a few studies 1-3 reporting the outcome in a substantial number of patients with long-term follow-up. The aim of this article is to report the long-term effects of Crohn's disease in a group of patients who were treated for 15 years or more at the Cleveland Clinic. Read at the meeting of the American Society of Colon and Rectal Surgeons, Houston, Texas, May 11 to 15, 1986. Address reprint requests to Dr. Fazio: Department of Colorectal Surgery, The Cleveland Clinic Foundation, 9500 Eudid Avenue, Cleveland, Ohio 44106. From the Departments o/Colorectal Surgery, Gastroenterology, and Biostatistics, The Cleveland Clinic Foundation, Cleveland, Ohio Method The charts of patients with a diagnosis of C, rohn's disease who presented at the Cleveland Clinic with the disease before 1965 were retrieved and examined. Those with histories of 15 years or more since presentation, who had no definitive surgical procedure for Crohn's disease before referral, and who received all subsequent treatment at this hospital, from the basis of this study. The diagnosis was confirmed in each case using the clinical, radiologic, and histopathologic criteria described by Lockhart-Mummery and MorsonA, 5 Patients not meeting these criteria or whose diagnosis was uncertain were rejected. For ease of computerization, the course of each patient's disease was recorded as a number of "events." An "event" was defined as any alteration in the status of the disease requiring a major change in medical or surgical treat- ment. Data recorded at each "event" included clinical features, anatomic extent of the disease, treatment, and complications. Definitive surgical procedures included bowel resections, internal bypass operations, and external fecal diversion, but not local surgery for peria~ disease i or incision and drainage of abscesses. ~ Patients were grouped into one of three anatomic'~ terns (small-bowel, large-bowel, and ileocolic) depending on the site and extent of disease at the time of diagnosis. 174