Long-term complications, extraintestinal manifestations, and mortality in adult Crohn's disease in population-based cohorts.
BACKGROUND
Crohn's disease (CD) is a chronic, progressive, destructive disease. Numerous intestinal and extraintestinal complications and manifestations can occur during its clinical course. This literature review summarizes our current knowledge of the long-term complications, extraintestinal complications, and mortality in CD in adults as reported in population-based studies that include long-term follow-up results.


METHODS
A literature search of English and non-English language publications listed in the electronic databases of Medline (source PubMed, 1935 to July, 2009).


RESULTS
The relative risk of incident fractures is increased in CD patients by ≈30%-40%. These patients have also have a 3-fold increased risk of deep venous thrombosis and pulmonary embolism. A variety of extraintestinal manifestations (primary sclerosing cholangitis, ankylosing spondylitis, iritis/uveitis, pyoderma gangrenosum, erythema nodosum) and diseases (asthma, bronchitis, pericarditis, psoriasis, rheumatoid arthritis, and multiple sclerosis) are associated with CD. The risks of colorectal and small bowel cancers relative to the general population are 1.4-1.9 and 21.1-27.1, respectively. A slightly increased risk of lymphoma, irrespective of medication use, has been reported in a recent meta-analysis of population-based studies. Overall mortality is slightly increased in CD, with a standardized mortality ratio of 1.4.


CONCLUSIONS
CD is frequently associated with disease complications and extraintestinal conditions. Whether the impact of changing treatment paradigms with increased use of immunosuppressives and biologic agents can reduce disease complications and associated conditions is unknown.
Peyrin-Biroulet
Laurent
L
Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Loftus
Edward V
EV
Colombel
Jean-Frederic
JF
Sandborn
William J
WJ
D000328:Adult; D002769:Cholelithiasis / Q000209:etiology*; D015331:Cohort Studies; D003424:Crohn Disease / Q000150:complications* / Q000453:epidemiology*; D004893:Erythema Nodosum / Q000209:etiology*; D006801:Humans; D017511:Pyoderma Gangrenosum / Q000209:etiology*; D013167:Spondylitis, Ankylosing / Q000209:etiology*; D013997:Time Factors