Improved Diagnosis of Crohn's Disease in a Low Endemic Area: A 15-Year Hospital-Based Study

Background/Purpose: Crohn's disease (CD) has increased in the Asia-Pacific area in the past two decades. There is not a single gold standard for diagnosing CD; diagnosis is usually made through a combination of clinical, endoscopic, histological, and radiological investigations. Previously, CD was usually diagnosed postoperatively by histological examination. The aim of this study was to elucidate the change in the diagnostic pattern for CD in our hospital over the past 15 years. Methods: A total of 36 CD patients were retrospectively enrolled from the electronic clinical database of Changhua Christian Hospital, Taiwan in the period of January 2000- October 2014. The clinical characteristics and pathological, endoscopic, and radiological findings were analyzed. Results: There was a significant increase in non-surgical diagnosis of CD over the past 15 years. Comparing CD data before and after 2011, the percentage of diagnoses made after surgery was higher before 2011 than after 2011 (35% vs. 6.3%, p = 0.042). Higher proportions of ileal disease (p = 0.03), stricturing disease (p = 0.046), and radiologic evidence of luminal stenosis (80%, p = 0.047) were noted among patients diagnosed with CD postoperatively. Inflammatory disease (p = 0.044) and an endoscopic finding of aphthous ulcers (54.2%, p = 0.025) were found more frequently in patients diagnosed with CD without surgery. Pathological findings of non-caseating granuloma were observed more frequently in surgical specimens as compared with endoscopic specimens (50.0% vs. 7.4%, p = 0.016). There were no significant differences in terms of age of diagnosis, sex, and perianal disease between patients diagnosed with CD with or without surgery. Conclusion: CD has increased in Taiwan in the past 15 years. In the early period, CD was diagnosed when complications occurred postoperatively, i.e., perforation or obstruction. The low yield rate of endoscopic biopsies and a lack of clinical suspicion contributed to delayed diagnosis of CD. There has been an increase in nonsurgical diagnosis of CD since 2011; early diagnosis has been more common in recent years due to clinical awareness of the disease, which has changed the diagnostic pattern.