Some clinical aspects of Crohn's disease in Northern Ireland: an aid to earlier diagnosis?

A retrospective epidemiological study of Crohn's disease in Northern Ireland between 1966 and 1981 has been carried out. Using strict diagnostic criteria 440 cases were identified and aspects of the clinical presentation of the disease at initial diagnosis were examined. This paper describes the clinical pattern of the major symptoms of the disease and highlights the delay in diagnosis. One-third of cases (32.7%) were not diagnosed until more than a year after the onset of symptoms and 7.5% of cases were not diagnosed for more than five years. Colicky abdominal pain, one of the classical diagnostic symptoms of Crohn's disease was not present at initial diagnosis in 28.6% of cases nor were altered bowel habits found in 24.5% of cases. Only 17.7% of cases had an abdominal mass, just over half had an elevated erythrocyte sedimentation rate or lowered haemoglobin level and only 39.8% had rectal bleeding.Increased awareness by general practitioners of the delay in diagnosis of Crohn's disease may lead to earlier investigation and diagnosis of the condition which in this community occurs with an incidence of 2.34 new cases per 100 000 of the population per year.