AIM: To know the epidemiology and outcome of Crohn’s
disease at King Khalid University Hospital, Riyadh, Saudi Arabia
and to compare the results from other world institutions.
METHODS: A retrospective analysis of patients seen for
20 years (between 1983 and 2002). Individual case records
were reviewed with regard to history, clinical, findings from
colonoscopy, biopsies, small bowel enema, computerized
tomography scan, treatment and outcome.
RESULTS: Seventy-seven patients with Crohn’s disease
were revisited, 13% presented the disease in the first 10 years
and 87% over the last 10 years. Thirty-three patients (42.9%)
were males and 44 (57.1%) were females. Age ranged
from 11–70 years (mean of 25.3±11.3 years). Ninety-two
(92%) were Saudi. The mean duration of symptoms was
26±34.7 mo. The mean annual incidence of the disease
over the first 10 years was 0.32:100 000 and 1.66:100 000
over the last 10 years with a total mean annual incidence
of 0.94:100 000 over the last 20 years. The chief clinical
features included abdominal pain, diarrhea, weight loss,
anorexia, rectal bleeding and palpable mass. Colonoscopic
findings were abnormal in 58 patients (76%) showing mostly
ulcerations and inflammation of the colon. Eighty nine
percent of patients showed nonspecific inflammation with
chronic inflammatory cells and half of these patients
revealed the presence of granulomas and granulations on
bowel biopsies. Similarly, 69 (89%) of small bowel enema
results revealed ulcerations (49%), narrowing of the bowel
lumen (42%), mucosal thickening (35%) and cobblestone
appearance (35%). CT scan showed abnormality in 68
(88%) of patients with features of thickened loops (66%)
and lymphadenopathy (37%). Seventy-eight percent of
patients had small and large bowel disease, 16% had small
bowel involvement and only 6% had colitis alone. Of the
total 55 (71%) patients treated with steroids at some point
in their disease history, a satisfactory response to therapy
was seen in 28 patients (51%) while 27 (49%) showed
recurrences of the condition with mild to moderate
symptoms of abdominal pain and diarrhea most of which
were due to poor compliance to medication. Seven patients
(33%) remained with active Crohn’s disease. Nine (12%) of bowel, 2 (2.5%) had steroid side effects, 6 (8%) with
perianal Crohn’s disease and five (6.5%) with fistulae.
CONCLUSION: The epidemiological characteristics of
Crohn’s disease among Saudi patients are comparable to
those reported from other parts of the world. However the
incidence of Crohn’s disease in our hospital increased over
the last 10 years. The anatomic distribution of the disease
is different from other world institutions with less isolated
colonic affection.
Al-Ghamdi AS, Al-Mofleh IA, Al-Rashed RS, Al-Amri SM,
Aljebreen AM, Isnani AC, El-Badawi R. Epidemiology and
outcome of Crohn’s disease in a teaching hospital in Riyadh.
World J Gastroenterol 2004; 10(9): 1341-1344
http://www.wjgnet.com/1007-9327/10/1341.asp |