Características clínicas de presentación y evolutivas de una cohorte de 48 pacientes con enfermedad de Crohn en Uruguay

Beatriz Iade; Carla Bianchi; Fabiana Espíndola

Authors

Beatriz Iade Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Clínica de Nutrición y Digestivo, Ex Profesora Adjunta
Carla Bianchi Gastroenteróloga
Fabiana Espíndola Socióloga

Keywords:

CROHN'S DISEASE, URUGUAY

Abstract

Objective: to describe clinical and on progress features in a cohort of patients with Chron disease.
Methods: a cohort of 48 patients from all over Uruguay with Chron disease was analyzed retrospective and prospectively. The patients, coming from both public and private health centers, initiated the disease between 1951 and 2003, and were assisted by the authors at least once before June 30, 2003. A score with the following variables: sex, age of beginning of the disease, family history of inflammatory intestinal disease, topography, perianal disease, extra intestinal manifestations, intestinal resection and mortality was built from clinical histories.
Results: the cohort showed 50% women and 50% men. Minimum age of beginning of the disease was 4 years and the maximum, 89, with a median of 25; 43,7% had colon compromise, 23% ileum, 16,7% ileum-colon y 16,7% proximal ileum; 52,2% presented perianal disease. Family history of EII was observed in five patients (10,4%), extra intestinal manifestations in seven patients (14,6%), 70% of them were articular. Median follow up was 12,3 years. Some patients (31.2%) underwent intestinal resection (20% more than one), with a median of 4 years from the beginning of the disease to the surgery; there was no significant differences relating to topography. Three patients died.
Conclusions: In this cohort, colon and perianal affections were higher than expected. Intestinal resection and morbimortality rates were low but not despicable considering the affected age group.

References

1) Sandler R, Glenn ME. Epidemiology of inflammatory bowel disease. In: Kirsner J. Inflamatory bowel disease. 5th ed. Philadelphia: W.B. Saunders, 2000: 89-112.
2) Fedorak RN, Thomsom ABR. Inflammatory Bowel Disease In: Thomsom ABR, Shaffer EA, eds. First Principles of Gastroenterology. 4th ed. Toronto: Astra, 2000: 326-72.
3) Feagan B, Richmond S. Epidemiology of Inflammatory Bowel Disease. In: Lichteinstein G. ed. The clinician’s Guide to Inflammatory Bowel Disease. Philadelphia: SLACK, 2003: 1-8.
4) Asher K, Sachar D, Salomon P. Enfermedad de Crohn. In: Feldman M, Scharschmidt B, Sleisenger M, eds. Enfermedades Gastrointestinales y Hepáticas. 6th ed. Philadelphia: W.B. Saunders, 2000: 1834-63.
5) Lashner BA. Clinical features, laboratory findings, and course of Crohn’s disease. In: Kirsner J. Inflamatory bowel disease. 5th ed. Philadelphia: W.B. Saunders, 2000: 305-14.
6) Brauer B, Korzenik J. Clinical features, course and laboratory findenings in Crohn’s didease. In: Lichteinstein G. ed. The clinician’s Guide to Inflammatory Bowel Disease. Philadelphia: SLACK, 2003: 41-57.
7) Arin-Letamendia A, Burusco-Paternain Mj, Borda-Celaya F, Pueyo-Royo A, Martínez-Echeverría A, et al. Epidemiological aspects of inflammatory bowel disease in Pamplona área. Rev Esp Enferm Dig 1999; 91(11): 769-76.
8) Flamenbaum M, Zenut M, Aublet-Cuvelier B, Larpent Jl, Fabre P, Abergel A, et al. Incidence of inflammatory bowel diseases in the department of Puy-de-Dome in 1993 and 1994. EPIMICI. Epidemiologie des Maladies Inflamma-toires Cryptogenetiques de l’Instestin Group. Gastroenterol Clin Biol 1997; 21(6-7): 491-6.
9) Pagenault M, Tron I, Alexandre Jl, Cruchant E, Dabadie A, Chaperon J, et al. Incidence of inflammatory bowel diseases in Bretagne (1994-1995). ABERMAD. Association Bertonne d’Etude et de Recherche des Maladies de l’Appareil Digesif. Gastroenterol Clin Biol 1997; 21(6-7): 483-90.
10) Wright Jp, Froggatt J, O’Keefe Ea, Ackerman S, Watermeyer S, Louw J. et al. The epidemiology of inflammatory bowel disease in Cape Town 1980-1984. S Afr Med J 1986; 70(1): 10-5.
11) Gutiérrez-Blanco H, Gutiérrez-Galiana H, Nin-Sacarelo R. Enfermedad de Crohn: a propósito de 85 casos. Prensa Med Urug 1984; 7: 75-9.
12) Lapidus A, Bernell O, Hellers G, Lofberg R. Clinical course of colorectal Crohn’s disease: a 35 year follow-up study of 507 patients. Gastroenterology 1998; 114(6): 1151-60.
13) Lapidus A, Bernell O, Hellers G, Persson Pg, Lofberg R. Incidence of Crohn’s disease in Stockholm county 1955-1989. Gut 1997; 41(4): 480-6.
14) Mckee Rf, Keenan RA. Perianal Crohn’s disease - is it all bad news? Dis Colon Rectum 1996; 39(2): 136-42.
15) Texeira MG, Habr-Gama A, Takiguti CK, Rocha ME, Dos-Santos H, Oliveira AL. Perianal manifestations in Crohn’s disease. Rev Hosp Clin Fac Med Sao Paulo 1996; 51(4): 125-30.
16) Rankin Gb, Watts Hd, Melnyk Cs, Kelley Ml Jr. National Cooperative Crohn’s disease study: extraintestinal manifestations and perianal complications. Gastroenterology 1979; 77(4 Pt 2): 914-20.
17) Sangwan YP, Schoetz DJ, Murray JJ, Roberts PL, Coller JA. Perianal Crohn’s disease. Results of local surgical treatment. Dis Colon Rectum 1996; 39(5): 529-35.
18) McClane SJ, Rombeau JL. Anorectal Crohn’s disease. Surg Clin North Am 2001; 81(1): 169-83.
19) Crespo-Uriguen M, Pérez-Lozana Jr, Pérez-Suárez A, Miyar-González. The extraintestinal manifestations of Crohn’s disease: our experience. Rev Esp Enferm Dig 1991; 80(3): 169-72.
20) Gravallese EM, Kantrowitz FG. Arthritic manifestations of inflammatory bowel disease. Am J Gastroenterol 1988; 83(7): 703-9.
21) Greenstein AJ, Janowitz HD, Sachar DB. The extra-intestinal complications of Crohn’s disease and ulcerative colitis: a study of 700 patients. Medicine (Baltimore) 1976; 55(5): 401-12.
22) Ghayad E, Haddad F, El-Aam C, Tohme A, Nasr W. Inflammatory intestinal diseases and their extra-intestinal manifestations observed at Liban. J Med Liban 1997; 45(4): 191-6.
23) Sachar DB. Indications for Surgery in Inflammatory Bowel Disease: A Gastroenterologist’s opinion. In: Kirsner J. Inflamatory bowel disease. 5th ed. Philadelphia: W.B. Saunders, 2000: 611-5.
24) Delaney CP, Fazio VW. Crohn’s disease of small bowel. Surg Clin North Am 2001; 81(1): 133-51.
25) Gollop JH, Phillips SF, Melton LJ 3rd, Zinsmeister AR. Epidemiologic aspects of Crohn’s disease: a population based study in Olmsted County, Minesota, 1943-1982. Gut 1988; 29(1): 49-56.
26) Cottone M, Martorana G, Di-Mitri R, Camma C, Caprilli R. Epidemiology of inflammatory bowel disease in Italy. Ital J Gastroenterol Hepatol 1999; 31(6): 503-7.
27) Loftus EV Jr, Silverstein MD, Sandborn WJ, Tremaine WJ, Harmsen WS, Zinsmeister AR. Crohn’s disease in Olmsted Country, Minesota, 1940-1993: incidence, prevalence, and survival. Gastroenterology 1998; 114(6): 1161-8.
28) Jess T, Winther K, Munkholm P, Langholz E, Binder V. Mortality and causes of death in Crohn’s disease: follow-up of a population-based cohort in Copenhagen country, Denmark. Gastroenterology 2002; 122(7): 1808-14.