Crohn’s disease (CD) is a chronic condition that can result in significant morbidity and disability. By studying the association between demographics and initial clinical features and subsequent natural history, one may be able to stratify patients by their risks of clinical relapse, hospitalization, and surgery. Understanding the potential environmental risk factors and natural history of CD in a given patient guides the physician when counseling the patient and selecting a treatment strategy. In this review, updated data regarding the incidence and prevalence of CD, important environmental risk factors, natural history of the disease, and important prognostic factors are discussed.
Key points
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The incidence and prevalence of Crohn’s disease in the Western world are continuously increasing, and are also rapidly increasing in newly industrialized countries, making Crohn’s disease a truly global disease.
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Cigarette smoking, low dietary fiber intake, high dietary fat intake, improved childhood hygiene, and various medications are important environmental risk factors for Crohn’s disease.
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Over time, the extent of Crohn’s disease remains mostly stable, whereas disease behavior changes over time, with more patients developing stricturing or penetrating complications.
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Risk factors for a more unfavorable clinical course of Crohn’s disease include younger age at diagnosis, extensive anatomic involvement, perianal disease, stricturing or penetrating behavior, deep ulcers, and prior surgical resection.
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