Natural history and long-term clinical course of Crohn’s disease

Core Tip

Core tip: Crohn’s disease remains an intriguing heterogeneous disorder characterized by a granulomatous inflammatory process. The phenotypic clinical expression of Crohn’s disease is clearly age-onset dependent as most children and adolescents suffer more severe, more extensive and more complicated disease than most adults, and the elderly. If evaluated over a long period of time, the disease appears to be progressive, but only intermittently active, with some appearing to have prolonged periods of sub-clinical disease and others expressing complex disease with stricture formation and penetrating complications, even at the time of initial clinical presentation. Although the precise cause of Crohn’s disease remains a mystery, an increasing appreciation for the long-term natural history may permit development of more effective treatment regimens. Ultimately, however, both clinical and fundamental investigative efforts should focus on discovering the cause of the disorder since this approach may offer the best opportunity for cure.