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Centre for Evidence-
Based Medicine

Crohn's Disease - Overall survival may be reduced

Clinical Bottom Line

Overall survival for Crohn's disease patients is 92% of that expected but only for patients diagnosed before 1974.

Citation

Loftus EV, Silverstein MD, Sandborn WJ, et al. Crohn's Disease in Olmstead County Minnesota, 1940-1993: Incidence, Prevalence, and Survival. Gastroenterology 1998;114:1161-1168.

Clinical Question

In a patient with newly diagnosed Crohn's disease what are the chances of dying prematurely?

Search Terms

"crohn's disease" and "survival" in Medline

The Study

  • 226 pts registered in a community-based Crohn's registry and followed prospectively for median of 13.4 years (range, 0.3-51.3) after diagnosis.
  • The Outcome: death
  • Well-defined sample at uniform (early) stage of illness? yes;
  • Follow-up long enough? yes;
  • Follow-up complete? reasonably (20% drop out);
  • Blind and objective outcome criteria? yes;
  • Adjustment for other prognostic factors? no;
  • Validation in an independent "test-set" of patients? no

The Evidence

Overall survival for Crohn's disease patients is 92% of that expected, but only for patients diagnosed before 1974.
Prognostic Factor Outcome Time Measure Confidence Interval
Crohn's disease Death 13.4 years 19% 13.9% to 24.1%

Comments

  1. Decreased survival only applies to patients diagnosed before 1974
  2. 90% of Olmstead population included
  3. Rely on diagnosis of Crohn's
  4. 20% lost in follow-up
  5. US study ? applicable worldwide?
  6. Small numbers in more recent decennial cohorts

Appraised By

W. Rosenberg, 1999

Expiry Date

2000