Crohn's disease: a patient's perspective.
OBJECTIVE
As healthcare providers for Crohn's disease, we assume that we have a good understanding of the disease progression and its symptoms. The aim of this study was to gather information about what patients with Crohn's disease think are relevant to their symptoms and what helps them cope with this lifelong benign disease.


METHODS
A questionnaire was sent to all patients with a diagnosis of Crohn's disease seen in the Digestive Disease Center in the last 5 years. The returned forms were downloaded into a database and sent for analysis.


RESULTS
Sixty-two percent of respondents were female. One third were between the ages of 35 and 50 years. Seventy percent were married. Thirty-eight percent had a graduate degree, 19% were unemployed. Fifty percent still smoked, half of them less than one pack a day. Sixty-eight percent said that their symptoms affected work, and one fourth changed jobs due to this. Foods worsened symptoms in 60%, with a decrease in symptoms while on low fiber foods and white meats. Lifestyle change worsened symptoms in 66%. A change in the caregiver was not a significant stressor. More than half used Remicade, with one third stating that it was helpful. Eight percent had never used steroids. Alcohol increased symptoms in 40%. Factors that did not cause a significant change were children at any age, pregnancy, menopause, and hormone replacement therapy. Surgery caused half the patients to improve for many years, although one third felt a lowered self-esteem postoperatively.


CONCLUSIONS
Patients with Crohn's disease should be managed in a more comprehensive manner to provide optimal care. Thus, a team approach that includes a dietician and counselor should be considered as an integral part of this team. This will allow patients to have enhanced skills to cope with changes in their symptoms, whether they are due to the disease itself or the changes in their routine.
Department of Colorectal Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk A-30, Cleveland, OH 44195, USA. zutshim@ccf.org
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D000223:Adaptation, Psychological; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D017281:Cost of Illness; D003424:Crohn Disease / Q000209:etiology / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy*; D004032:Diet / Q000009:adverse effects; D013505:Digestive System Surgical Procedures; D004522:Educational Status; D004651:Employment; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D000069285:Infliximab; D008019:Life Style; D008297:Male; D017533:Marital Status; D008597:Menstrual Cycle; D008875:Middle Aged; D010348:Patient Care Team; D010353:Patient Education as Topic; D010361:Patients / Q000523:psychology* / Q000706:statistics & numerical data; D010465:Perception; D011788:Quality of Life; D012307:Risk Factors; D012649:Self Concept; D012907:Smoking / Q000009:adverse effects; D013315:Stress, Psychological / Q000209:etiology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014887:Weather
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab