Clinical aspects of Crohn's disease of the upper gastrointestinal tract: a comparison with distal Crohn's disease.

OBJECTIVE

Our objective was to compare the clinical characteristics of 72 patients with proximal Crohn's disease (PCD), i.e., from mouth through jejunum, with those of 242 patients with distal Crohn's disease (DCD), i.e., from ileum through rectum.

METHODS

The diagnosis of Crohn's disease was made on established criteria, e.g., radiology, histology, etc.

RESULTS

All but one patient with PCD eventually had DCD as well. Twenty-seven of the 72 patients in the PCD group had manifest PCD at the time of diagnosis. For the 45 PCD patients who, at first, had only distal lesions, 5.0 +/- 4.2 yr passed before a proximal localization was detected. After the diagnosis had been established, the average follow-up time was 19.2 yr in the PCD group and 23.1 yr in the DCD group. The age at onset of disease was significantly (p < 0.01) lower in the PCD group (19.1 yr) than in the DCD group (24.3 yr). However, the time from onset of first symptoms to diagnosis was almost identical in the two groups (PCD group 3.8 yr vs. DCD group 3.4 yr). When complaints began in 1970 or later, after introduction of the flexible endoscope, there was a significant difference between length of time-to-diagnosis in the PCD and DCD groups, i.e., 2.7 and 1.6 yr, respectively, (p < 0.05). Remarkable differences were found in initial symptoms at the onset of disease. Abdominal pain and/or cramps and general malaise were found more often in patients with PCD (respectively, 82% and 21%) than in patients with DCD (respectively, 70% and 10%) (both p < or = 0.05). Although small-bowel resections were performed comparably often in the two groups, in the PCD group, the average length of resected small bowel was significantly greater (77.3 cm, p < 0.002) (n = 53) than in the DCD group (48.1 cm, n = 165).

CONCLUSIONS

We conclude that PCD differs from DCD in its clinical presentation, particularly with regard to abdominal pain and/or cramps and general malaise. Patients with PCD are younger at the onset of symptoms, at diagnosis, and when the first abdominal operation is performed, but there is no difference in lag times compared with those of DCD patients. During the course of the illness, more small bowel is resected from PCD patients.