Fenotipo e historia natural de la enfermedad inflamatoria intestinal en un centro de referencia en Medellín-Colombia

Worldwide the frequencies of inflammatory bowel disease, ulcerative colitis and Crohn's disease have all increased. In our own environment it has become necessary to establish the epidemiology of these entities and to determine their clinical and endoscopic behavior. Methodology: This is a descriptive observational study which systematically evaluated patients with inflammatory bowel disease at the Pablo Tobon Uribe Hospital between August 2001 and July 2009. Results: Of 202 patients with diagnoses of inflammatory bowel disease 80.7% had ulcerative colitis and 15.8% had Crohn's disease. The ratio was 4.9 to 1 with similar distributions among male and female patients. Patients with ulcerative colitis presented more diarrhea and bleeding, but less abdominal pain and weight loss, than those with Crohn's disease. This difference was significant (p <0.001). The percentage of our patients with extraintestinal manifestations (27.7%) was similar to other populations in which compromised articulation predominates. A significant association between smoking and Crohn's disease was found. 19.5% of our patients had proctitis, 45% had left sided colitis, and 35.5% had extensive colitis. The most common location of Crohn's disease was in the ileocolonic region (50%), while 18.8% were located in the terminal ileum, and 28.1% were in the colonic region. Only 3.1% had upper gastrointestinal tract involvement. Severity of symptoms ranged from asymptomatic or S0 (17.2%) to severe or S4 (23.1%) at study entry. 27.8% had mild activity (S1), and 32.0% had moderate activity (S2). Of the patients with Crohn's disease, 34.4% presented inflammatory (INF) behavior, 31.3% had fi brostenotic (FS) behavior, 21.9% were perianal, 6.3% had fi stulizing/ perforating (FP) behavior and 6.3% had fi brostenotic (FS) behavior and were perianal. Biological therapy was only used for 7.4% of the patients with ulcerative colitis and 46.9% of the patients with Crohn's disease. The colectomy rate for patients with ulcerative colitis was 6.0%. It was significantly related to severity (S3) and extension (extensive colitis). 50% of the patients with Crohn's disease had surgical resections. INF patients had surgery less often than other patients. The mortality rate of our patients during follow-up was 2.4% for ulcerative colitis patients and 3.0% for Crohn's disease patients. Conclusion: Despite finding a predominance of ulcerative colitis, there is a tendency to increased detection of Crohn's disease similar to what has been reported in other centers. In our environment ulcerative colitis has relatively benign behavior with low surgery and low mortality rates. Crohn's disease patients present more severe behavior, and have higher rates of hospitalization, surgery and use of biological therapy. This is probably associated with delays in patients treatment after the initial diagnosis has been made.