An analysis of an inflammatory bowel disease practice in an urban community hospital

OBJECTIVES: To review an individual community gastroenterologist's experien ce with inflammatory bowel disease (IBD). The aspects studied were distribu tion of disease, need for hospital admission, immunosuppressants, systemic steroids, and surgery and its indications. The incidence of cancer was also reviewed. PATIENTS AND METHODS: The charts of all IBD patients (n = 373) seen between 1993 and 1996 by an individual gastroenterologist in an urban community ho spital were reviewed for the aforementioned information. Patients seen duri ng this period may have been diagnosed with IBD before or during the period of 1993 to 1996. RESULTS: Of the 373 patients, 219 had Crohn's disease (CD) and 154 had ulce rative colitis (UC). The most common age of onset for both groups was 20 to 29 years. Distal UC and distal Crohn's colitis patients rarely required su rgery, hospitalization, systemic steroids or immunosuppressants. Eighty per cent of patients with small bowel CD and 51% of those with ileocolonic CD required at least one operation. Of the UC patients, 10.4% required surgery . Of the UC patients undergoing surveillance for cancer, none developed can cer but one developed significant dysplasia. CONCLUSIONS: In both CD and UC the site of the inflammation plays a major r ole in determining the need for hospitalization, surgery, systemic steroids and immunosuppressants. Distal UC, the most common form of UC in this grou p of patients, is a very benign disease. Of all forms of IBD, small bowel C D had the greatest need for hospitalization, surgery and systemic steroids.