DEATH FROM CROHNS-DISEASE - LESSONS FROM A PERSONAL-EXPERIENCE

We traced 1,000 patients with Crohn's disease hospitalized at Lenox Hi ll Hospital in New York City during 1972-1987 to identify those who di ed, the events preceding death, and their relationship to Crohn's dise ase. We considered any management early in the disease that might have influenced outcome. We introduce the term ''virulent'' Crohn's diseas e to describe those patients with most or all of the following: young age at onset, multiple surgical procedures, short bowel/malabsorption, chronic steroid therapy, narcotic addiction, and sepsis. Twenty-five patients (2.6%) had died. Major events preceding 18 deaths related to Crohn's disease were virulent Crohn's disease (six), gastrointestinal neoplasms (six), complications in the elderly (five), and complication s of drug therapy (one). Those seven deaths probably unrelated to Croh n's disease were attributed to extraintestinal neoplasms (four) and my ocardial infarction (three). Death was related to Crohn's disease or i ts treatment in 72% and perhaps in all. Ten of the 25 died at age 46 o r younger (mean 36 years, range 25-46 years). Twenty-two (88%) who die d had undergone surgery for Crohn's disease (mean 3.3 procedures) incl uding eight who died postoperatively (six elderly), attributable to se psis in seven and pulmonary embolism in one. The events preceding deat h suggest that early aggressive nonoperative therapy for severe Crohn' s disease warrants a careful controlled evaluation.