title: Long-term course of Crohn's disease in Japan: Incidence of complications, cumulative rate of initial surgery, and risk factors at diagnosis for initial surgery.
abstract: OBJECTIVE
  Intestinal complications of stenosis or fistula may occur during the course of Crohn's disease (CD), and surgery is performed in a fair number of patients. The risk factors for initial surgery in a Japanese hospital-based cohort of CD patients were evaluated.
  
  
  METHODS
  This study was a single-center, retrospective, cohort study. The subjects were 520 patients who underwent inpatient and outpatient treatment at our hospital, had a definitive diagnosis of CD, and no previous surgery. Three parameters were investigated: (i) cumulative incidence of stenosis and fistula; (ii) cumulative rate of initial surgery for each disease type; and (iii) risk factors at diagnosis for initial surgery.
  
  
  RESULTS
  (i) Stenosis and fistula increased with time, with stenosis or fistula appearing in about half of the patients after 5 years. (ii) The cumulative rate of initial surgery was about 50% after 10 years. (iii) The patient factors at diagnosis of current smoker, upper gastrointestinal disease, stricturing, penetrating, moderate to severe stenosis of the jejunum, moderate to severe stenosis of the ileum, and moderate to severe stenosis of the terminal ileum were risk factors for initial surgery.
  
  
  CONCLUSIONS
  Stenosis or fistula appeared in about half of the patients after 5 years from diagnosis. When upper gastrointestinal disease or complicated small intestinal lesions are seen at the time of diagnosis, the cumulative rate of initial surgery is significantly higher.
authors.affiliation: Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Yuho
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Matsui
authors.affiliation: Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yano
authors.affiliation: Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Kozue
authors.initials: K
authors.lastname: Tsurumi
authors.affiliation: Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Okado
authors.affiliation: Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Matsushima
authors.affiliation: Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Koga
authors.affiliation: Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Kazeo
authors.initials: K
authors.lastname: Ninomiya
authors.affiliation: Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Ono
authors.affiliation: Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Noritaka
authors.initials: N
authors.lastname: Takatsu
authors.affiliation: Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Beppu
authors.affiliation: Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nagahama
authors.affiliation: Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Hisabe
authors.affiliation: Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Takaki
authors.affiliation: Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Fumihito
authors.initials: F
authors.lastname: Hirai
authors.affiliation: Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Kenshi
authors.initials: K
authors.lastname: Yao
authors.affiliation: Department of Surgery, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Daijiro
authors.initials: D
authors.lastname: Higashi
authors.affiliation: Department of Surgery, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Kitaro
authors.initials: K
authors.lastname: Futami
authors.affiliation: Department of Community Health and Clinical Epidemiology, St. Mary's College, Kurume, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Washio
mesh_terms: D015331:Cohort Studies; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007412:Intestinal Fistula / Q000453:epidemiology* / Q000209:etiology; D007415:Intestinal Obstruction / Q000453:epidemiology* / Q000209:etiology; D007564:Japan / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
keywords: Crohn's disease; cumulative rate of initial surgery; fistula; risk factor for initial surgery; stenosis