Clinical patterns of Crohn's disease in Greece: A follow-up study of 155 cases

The aim of this prospective study was to elucidate the clinical features an d natural history of Crohn's disease in Greece. One hundred and fifty-five Greek patients with definite diagnosis of Crohn's disease were followed-up for a mean period of 9.7 years and evaluated for clinical patterns and cour se of illness. The male/female ratio was 1.58:1. The peak incidence of the disease was observed between 20 and 30 years of age. The majority of patien ts were urban dwellers and of higher socio-economic level compared to the g eneral population of Greece. In almost 50% of the patients symptoms of the disease started below the age of 30, although in almost one in every 5 case s, symptoms appeared after the age of 50. Familial clustering of inflammato ry bowel disease was observed in 1.3%. The pattern of anatomic involvement was: ileocolic 33.3%, colon 33.3% and small bower 33.3%. The kind of predom inant symptoms at the time of diagnosis was related to the anatomic locatio n of the disease. At least one extraintestinal manifestation appeared in 42 % of patients. Perianal disease was noticed in 21.3% with fistulae and absc esses being the most common manifestation. Fifty-one percent of patients we re operated upon at least once during the follow-up period because of acute abdomen, bad response to conservative treatment and fistulae and abscesses . Emergency operation was required in 17.3% of the patients. Evolution to c ancer was observed in 3 patients (2%). During the follow-up period of 9.7 /- 6.5 years, 18 patients (11.6%) died. A considerable mortality was notice d in the surgically treated group of patients, while in the nonoperated gro up the disease was running with milder symptoms. it is concluded that some of the clinicoepidemiological characteristics of patients with Crohn's dise ase in Greece are in accordance with those reported from western as well as the neighboring Mediterranean countries. However, other parameters such as the higher incidence of the disease in males, the low incidence of familia r clustering, and the low incidence of perianal disease, underline the impo rtance of environmental, genetic and other factors on the evolution and beh avior of the disease in different parts of the world. Copyright (C) 2000 S. Karger AG, Basel.