Introduction African Americans are traditionally underrepresented in most large IBD trials; thus, the natural history of the disease in this subpopulation is unclear.
Methods We preformed a retrospective study of African American patients with Crohn's disease from three teaching hospitals; 55 patients were enrolled. A combination of telephone interview and an extensive chart review were used to identify disease location, presence and location of fistulae and perirectal disease, surgical history, medication use, and presence of extraintestinal manifestations. All non-African American patients and patients with indeterminant or ulcerative colitis were excluded.
Results The average patient age was 42.6 years (range 20-73) and average age at diagnosis was 29.8 years. CD was most commonly located in the small bowel and colon (33/55, 60%), but isolated colonic disease was present in 16/55 (29.1%), and isolated small bowel disease in 3/55 (5.5%). Overall, colonic disease was present in 49/55 (89.1%). Average age at diagnosis of patients with small bowel and colonic disease was 26.1 years, while those with colonic disease alone had an average age of 37.8 years. Fifteen of 55 (27.3%) patients enrolled had a history of bowel resection. Of those, 6/15 (40%) had resection of colon only, 2/15 (13.3%) small bowel only, and 7/15 (46.7%) had undergone resection of small bowel and colon. Seventeen of 55 (30.9%) had a history of colostomy or ileostomy. Sixty percent (33/55) of patients had a history of fistulae. By far the most common were perirectal fistulae, found in 26/33 patients (78.7%); 48.9% of patients reported complete compliance with medication, 48.9% had previously taken 6-mercaptopurine (6MP) or azathioprine (AZA), and 22.2% of patients had previously taken infliximab. Average number of episodes of steroid courses was 5.4, and average duration of use was 6.4 months. Extraintestinal manifestations were present in 45.5%. The most common was arthritis or arthralgia, in 41.8% of those patients.
Summary and Conclusions This study of African Americans with CD shows a higher rate of colonic involvement and colonic resection than previously suggested. There is also a high rate of fistulizing disease, particularly perirectal fistulae. Extraintestinal disease is common in this group, with arthralgias and arthritis being the most common. These findings lend credence to the suggestion that CD may have different disease manifestations and course in African Americans.
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