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CLINICAL PRESENTATION OF CROHN'S DISEASE IN PAKISTAN
Author(s) -
Khan Rustam,
Abbas Zaigham,
Memon Sadik,
Hamid Saeed,
Shah Hasnain,
Jafri Wasim
Publication year - 2001
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2001.ca01-21.x
Subject(s) - medicine , abdominal pain , pancolitis , crohn's disease , disease , colonoscopy , gastroenterology , diarrhea , inflammatory bowel disease , surgery , colorectal cancer , cancer
Crohn's disease is uncommon in Pakistan and local demographic data is not available. Due to high prevalence of intestinal tuberculosis, it is often misdiagnosed and mismanaged. Aim of this study is to review the clinical presentation of Crohn's disease in our region. Methods Medical records of 475 adult patients admitted during the last 13 years with label of Crohn's disease were reviewed for the presence of Crohn's disease. Symptoms and signs, activity of the disease, site of involvement and the management offered was recorded. Results Diagnosis of Crohn's disease was made in 52 patients (29 females, 23 males). Mean age was 40.1 + 14.1 years. Disease was classified as inflammatory in 71%, obstructive in 15% and fistulizing in 14% cases. Disease activity was mild in 62%, moderate in 34% and severe in 4% cases. Pancolitis with skip lesions was the most common presentation present in 24 (46%) patients. Out of these 11 (21%) patients also had terminal ileum involvement. Ileocaecel disease was seen in only nine (17%) and isolated ileal disease in three (6%) patients. Another 11 (21%) patients showed one‐sided colitis. Predominant symptoms were diarrhea (88%), abdominal pain 83%, bleeding per‐rectum (52%), weight loss (48%), fever (37%), loss of appetite (27%), anal pain (10%) and jaundice (6%). Abdominal tenderness was present in 60%, pallor in 52% and abdominal mass in 15%. Anal signs were present in 25% of patients and included tags, fissures and abscesses. Extra intestinal manifestations were arthritis in seven (13%), sclerosing cholangitis in four (7.6%) and ankylosing spondylitis in two (3.8%). The patients were treated with steroids, 5‐aminosalisylic acid, azathiprine, metronidazole and antibiotics. Decision‐making was difficult in five patients who were initially treated with antituberculous drugs. Conclusion Crohn's disease exists in Pakistan and should be considered in the differential diagnosis of inflammatory diseases of colon and intestine. It is important to rule out tuberculosis in these cases. The disease activity in our region is usually mild to moderate with predominant inflammatory pattern. Colon is most common site of involvement.