Esophageal, Gastric, and Duodenal Histologic Findings in Patients with Feeding Difficulties

Currently, there are inconsistencies in the recommendations of when to obtain an esophagogastroduodenoscopy (EGD) in children with feeding difficulties. The aim of our study was to identify EGD findings in patients presenting to a large, outpatient feeding program. Additionally, we investigated the presence of any relationship between abnormal pathology seen on biopsies (inflammation) and symptoms of feeding intolerance such as vomiting, gagging, retching, or abdominal pain. Retrospective analysis of electronic medical records (EMRs) was conducted for all new patients aged 0-17 years presenting to the Multidisciplinary Feeding Clinic. Three hundred and thirty patients (50.2%) had an EGD with complete biopsies. Of these 330 patients, biopsies revealed esophagitis in 40%, gastritis in 33.6%, and duodenitis in 15.2%. Overall, 61.21% had an abnormal pathology in at least one site. We found that children with feeding disorders commonly have esophagitis, gastritis, and/or duodenitis and that symptoms are poor predictors of pathology. This study underscores the importance of gastrointestinal evaluation as part of a multidisciplinary evaluation in patients with feeding difficulties.

Mesenteric vascular dysregulation and intestinal inflammation accompanies experimental spinal cord injury

Cervical and high thoracic spinal cord injury (SCI) drastically impairs autonomic nervous system function. Individuals with SCI at thoracic spinal level 5 (T5) or higher often present cardiovascular disorders that include resting systemic arterial hypotension. Gastrointestinal (GI) tissues are critically dependent upon adequate blood flow and even brief periods of visceral hypoxia triggers GI dysmotility. The aim of this study was to test the hypothesis that T3-SCI induces visceral hypoperfusion, diminished postprandial vascular reflexes, and concomitant visceral inflammation. We measured in vivo systemic arterial blood pressure and superior mesenteric artery (SMA) and duodenal blood flow in anesthetized T3-SCI rats at 3 days and 3 wk postinjury either fasted or following enteral feeding of a liquid mixed-nutrient meal (Ensure). In separate cohorts of fasted T3-SCI rats, markers of intestinal inflammation were assayed by qRT-PCR. Our results show that T3-SCI rats displayed significantly reduced SMA blood flow under all experimental conditions (P < 0.05). Specifically, the anticipated elevation of SMA blood flow in response to duodenal nutrient infusion (postprandial hyperemia) was either delayed or absent after T3-SCI. The dysregulated SMA blood flow in acutely injured T3-SCI rats coincides with abnormal intestinal morphology and elevation of inflammatory markers, all of which resolve after 3 wk. Specifically, Icam1, Ccl2 (MCP-1), and Ccl3 (MIP-1α) were acutely elevated following T3-SCI. Our data suggest that arterial hypotension diminishes mesenteric blood flow necessary to meet mucosal demands at rest and during digestion. The resulting GI ischemia and low-grade inflammation may be an underlying pathology leading to GI dysfunction seen following acute T3-SCI.

[THE EFFECTIVENESS OF A 10-DAY DRUG THERAPY IN CHILDREN WITH CHRONIC GASTRODUODENAL PATHOLOGY ASSOCIATED WITH CAGA-POSITIVE STRAINS OF HELICOBACTER PYLORI]

The results of triple Helicobacter-therapy (omeprazole, amoxicillin, nifuratel) in the treatment of chronic gastroduodenal pathology in children depending on the duration of it's use. The effectiveness of drug therapy was evaluated in terms of eradication of Helicobacter pylori and dynamics of pain, dyspeptic syndrome and astenovegetative syndrome.

[CLINICAL FEATURES AND OPTIMIZATION OF THE TREATMENT OF CHILDREN WITH COMBINATION GASTRODUODENAL PATHOLOGY AND PRIMARY HYPERTENSION]

The paper present dynamic of clinical picture, daily blood pressure monitoring results and subjective assessment of functional status in children with combination of chronic gastroduodenal pathology and primary hypertension when L-carnitine used with the standard treatment regimen.

[THE CORRECTION OF TROPHIC DISORDERS IN CHILDREN OF CHRONIC GASTRODUODENITIS WITH METHOD LOW-FREQUENCY LIGHT-MAGNETOTHERAPY]

The results of a survey of school children with chronic gastroduodenitis when applying at an early period the medical rehabilitation with method low-frequency light-magnetotherapy. During treatment of hospital was evaluated vegetative-trophic status with methods of cardiointervalography and thermovision functional tests. In normalizes clinical parameters was correction in dynamics of the vegetative status in children, it confirms the effectiveness of the therapy. It is proved, that the use of low-frequency light-magnetotherapy has a positive effect on the vegetative--trophic provision an organism and normalizes the vegetative dysfunction.

[VASCULAR ENDOTHELIAL GROWTH FACTOR AND SOME INDICATORS OF ENDOTHELIAL DYSFUNCTION OF PATIENTS HAVING CHRONIC INFLAMMATORY DISEASES OF THE GASTRO DUODENAL ZONE]

The aim of the study was to determine the content of vaskuloendotelian growth factor and nitric oxide in children with chronic inflammatory diseases of the stomach and duodenum. The study involved 63 children with chronic inflammatory diseases of the gastroduodenal zone. Substrate study was serum. The data obtained were compared with a group of healthy children. The highest possible content vaskuloendotelian growth factor noted in the group of children with duodenal ulcer in the acute phase and in the group of chronic gastroduodenita associated with Helicobacter pylori. According to the results of the study established the role of nitric oxide and vaskuloendotelian growth factor in the pathogenesis of gastroduodenal diseases.

[Morphological features and esophago-gastroduodenal zone microbiocenose in patients with syndrome postcholecystectomic syndrome]

Endoscopical and histological features of oesophagogastroduodenal zone, parameters of pH-metry and electrogastroenterography, qualitative and quantitative characteristics of microbiocenosis were studied in 80 female persons with postcholecystectomy syndrome more then a year after cholecystectomy. In the presence of duodenogastral reflux the most natural is the combination of distal oesophagitis, antral atrophic gastritis and duodenitis, accompanied with low level of gastric acidity, gastric hypokinesis and duodenal dyskinesis, dysbacteriosis of mucosal microflora with its quantitative increase and appearance of bacteria with expressed pathogenicity non-typical for this biotope. These data should be taken into consideration for determination of pre- and postoperative treatment tactics for patients with gallstones.

[Treatment of chronic erosive gastroduodenitis in children with hypercapnic hypoxia]

Investigation of quality of life in pediatric patients--a simple, reliable and efficient way to assess the status of the child, which complements the clinical, laboratory and instrumental examination, which in turn helps to improve treatment outcomes. Given that the gastro-intestinal tract, the prevalence of the 2nd place among all the diseases of childhood, the definition of quality of life and its improvement in such patients is an integral part of treatment.

[Characteristics of aggressive and protective factors in erosive lesions of gastroduodenal mucosa]

AIM

To investigate aggressive-protective factors in patients with erosive lesions of gastroduodenal mucosa.

MATERIAL AND METHODS

Intragastric pH-metry, tests for Helicobacter pylori, lysozyme activity, content of bile acid in gastric juice, components of gastric mucous gel were made in 106 patients.

RESULTS

It is shown that there are two alternative paths of erosions development in the gastroduodenal zone: infectious and non-infectious.

CONCLUSION

In patients infected with Helicobacter pylori, lowering of a protective ability of the mucous gel is caused by prevalence of synthesis of immature mucous components while in non-infected patients this happens as a result of high catabolism of mucous components.

[Dynamics of the morphofunctional status of digestive organs in patients with chronic gastroduodenitis during monotherapy with sulfate sodium-calcium mineral water]

The authors describe morphofunctional changes in gastroduodenal tract in patients with chronic gastroduodenitis. Some of them have previously undergone laparoscopic cholecystectomy for cholelithiasis. Balneotherapy with mineral water "Uvinskaya" has a good effect in the above disease and therefore is recommended for prevention and treatment of patients with chronic gastroduodenitis as well as for prevention of repeated cholelithiasis after cholecystectomy.

[A status of the adaptational region of the autonomic nervous system in children with chronic gastroduodenitis living under ecologically unfavorable conditions]

The authors carry out the analysis of adaptation disorders of a link of vegetative of nervous system at children with chronic gastroduodenitis, living under poor ecological conditions. It is shown, that in these patients the power of vagus connections with vegetal nervous system prevails. In loading test, the inadequacy of adaptation comes to light. The accumulation of Mn and Cr in the blood serum is accompanied by high power of sympathetic connections with vegetal nervous system and accumulation of Ph in the blood serum--by high power of parasympathetic connections with vegetal nervous system.

[Effect of food deprivation on the proteolytic system in patients with atopic bronchial asthma concurrent with gastroduodenitis]

The article contains data on the state of the proteolysis system in the systemic blood flow and locally in the duodenal mucosa in those patients with bronchial asthma concurrent with gastroduodenitis. Results of fasting dietetic management versus medicamentous treatments showed a complete normalization of the protease-antiprotease imbalance with food deprivation.

[When is H pylori a cause of duoenal ulcer? Hypersecretion of gastric acid, active duodenitis and reduced bicarbonate secretion are links in the chain]

Helicobacter pylori infection engaging mainly the gastric antrum causes hypersecretion of gastric acid. The increased duodenal acid load gives rise to islands of gastric mucosa in the proximal duodenum. As these bacteria thrive only on gastric mucosa it presents an opportunity for Helicobacter pylori to colonize the duodenum. A much higher density of virulent Helicobacter pylori has been found in the duodenum of duodenal ulcer patients in comparison to infected subjects without duodenal ulcer. The high density of virulent Helicobacter pylori in the proximal duodenum results in a strong inflammatory reaction with active duodenitis and impaired bicarbonate secretion. These characteristics of duodenal ulcer patients, together with the acid hypersecretion, seem to be the key factors in evoking a duodenal ulcer.

Differences in surface-exposed antigen expression between Helicobacter pylori strains isolated from duodenal ulcer patients and from asymptomatic subjects

We have analyzed possible qualitative and quantitative differences in antigen expression between Helicobacter pylori strains isolated from the antrum and different locations in the duodenum of 21 duodenal ulcer (DU) patients and 20 asymptomatic subjects (AS) by enzyme-linked immunosorbent assay (ELISA) and inhibition ELISA. Almost all antral and duodenal strains grown in vitro expressed the N-acetyl-neuroaminyllactose-binding hemagglutinin, flagellins (subunits FlaA and FlaB), urease, a 26-kDa protein, and a neutrophil-activating protein. In 75% of both the DU patients and the AS, antral H. pylori strains expressed either the blood group antigen Lewis y (Le(y)) alone or together with the Le(x) antigen. However, duodenal H. pylori strains of DU patients expressed Le(y) antigen more frequently than corresponding strains of AS (P < 0.05). Presence of Le(y) on H. pylori was related to the degree of active duodenitis (P < 0.05). Duodenal H. pylori strains isolated from AS were significantly more often Lewis nontypeable than duodenal strains of DU patients (P < 0.01). Presence of H. pylori blood group antigen-binding adhesin (BabA) was significantly higher on both antral and duodenal strains isolated from DU patients than on corresponding strains isolated from AS (P < 0.05). BabA-positive duodenal H. pylori strains isolated from DU patients were associated with active duodenitis more frequently than corresponding strains isolated from AS (P < 0.01). Infection with H. pylori strains positive for Le(y) and BabA in the duodenum is associated with development of duodenal ulcer formation.

[The short-term effect of measured normobaric hypoxia on autonomic nervous system function in persons with hypo- and hyperacidic syndromes]

The functional activity of the vegetative nervous system was studied before and after the exposure to graded normobaric hypoxia having been realized as breathing with an artificial hypoxic mixture (AHM) during 10 to 40 minutes in subjects presenting with hypo- and hyperacidic syndromes. A relationship was established between activation of the sympathetic or parasympathetic regions and aggravation of the antecedent history (bad habits). It is suggested that a short-term AHM breathing be used as a test for preservation/failure of mechanisms of adaptation.

Churg-Strauss syndrome diagnosed and followed with gastrointestinal fiberscopic studies and electroneuromyography

Churg-Strauss syndrome (CSS) is a disorder characterized by hypereosinophilia and systematic vasculitis occurring in individuals with bronchial asthma. We present a case of 24-year-old woman with CSS diagnosed by and followed with gastrointestinal fiberscopic examination and electroneuromyography. The duodenal biopsy showed granulomatous angiitis with eosinophilic infiltration, and the electroneuromyography showed peripheral nerve dysfunction. After steroid treatment, the duodenal erosion and ulcer were almost completely resolved. There was no improvement in electroneuromyography, but the patient was able to walk independently after intensive rehabilitative training.

[The use of mountain air therapy for the correction of acid formation in patients with hypo- and hyperacidic syndromes]

Changes were studied in intragastric pH with the aid of micromethods of topo-pH-metry in 46 patients presenting with hypo- and hyperacidic syndrome exposed to artificial mountain air (AMA) therapy. The gas mixture containing 14% oxygen was formed by using molecular sieves. AMA was found out to have a significant sanogenic effect: it makes for acid production in patients with hypoacidic syndrome and reduces the above production in those patients presenting with hyperacidic syndrome AMA therapy administered along with the judicious employment of blockers, Hs-histamine receptors will, we believe, help in alleviating and dispelling the withdrawal syndrome.

[The assessment of the mental health of children with psychosomatic diseases]

The mental health of children and adolescents who suffered from gastrointestinal diseases due to psychosomatic causes (duodenal ulcer, chronic gastroduodenitis) was examined. Those with the diseases are a group at risk for nervous and mental disorders, and impaired psychophysical adaptation.

[The effect of nitrogen silicide thermal mineral water on stomach function in gastroduodenal pathology]

Patients with ulcer, hyperacid and normal acid gastritis were given nitrogen silicate mineral water from Annensk thermal springs. The water was found to inhibit acid-pepsin-forming function and to improve gastric motility and evacuation. Acceptable fluoride concentration and not a single case of the disease aggravation make the above mineral water suitable for rehabilitation of patients with ulcer and gastritis.

[The combined action of sinusoidal modulated currents and ultrasound in the treatment of chronic gastroduodenitis in children]

The paper summarizes the results of clinical observations and special examinations conducted in 45 children with chronic gastroduodenitis by using combined exposure to sinusoidal modulated currents and ultrasound. The dynamics of clinical symptoms, functional status of the stomach and its adjacent gastroduodenal organs, endoscopic findings, morphological status of the gastroduodenal mucosa, gastric mucosal dissemination of Helicobacter pylori, systemic and regional humoral immunological parameters, abdominal echography indicate high therapeutical efficiency of the combined therapy as compared to that performed in controls (without physiotherapy). Mechanisms of formation of therapeutical action are clarified, differentiated indications are defined.

Mucosal blood flow in erosive duodenitis

Erosive duodenitis is a clinical entity whose pathogenesis is still obscure. Acid secretion is mostly normal, while the possible role of vascular factors has been suggested. We measured mucosal blood flow by means of laser Doppler velocimetry during endoscopy in the duodenal bulb of 10 subjects with erosive duodenitis, 10 duodenal ulcer patients, and 10 healthy controls. Duodenal blood flow in erosive duodenitis was significantly reduced (p < 0.001) compared with controls, whereas no changes were detected in duodenal ulcer. Reassessment of mucosal blood flow after a 6-week treatment with ranitidine failed to show any increase in the perfusion values even in patients with endoscopic healing. Our results suggest that impaired mucosal blood flow is a primary factor in the pathogenesis of chronic duodenal erosions.

[Tubeless methods of the assessment of functional state of digestive organs in hormonal disorders]

The function of the stomach, pancreas, and intestine was studied in patients with chronic duodenitis without resorting to intubation. Disordered relationships between the hormones participating in the functioning of the hypophyseo-antral and entero-thyroid axis, resulting in trophic disorders in the gastroduodenal zone, are associated with characteristic shifts shown by methods of investigation other than intubation: drastically increased acid production in the presence of unchanged activity of urinary amylase before and after nutrient stimulation, combined with amylasorrhea. Diagnostic methods without intubation can earlier detect gastroduodenal diseases of dyshormonal etiology, particularly in children. Such methods may be used for initial screening, preceding more profound studies of both the hormonal status and the function of the organs of digestion.

[Drug effects on gallbladder motility (based on dynamic ultrasonic data)]

Ultrasound registration of changes in gallbladder volume by the method of cylinder sum allows reliable means of studying gallbladder contractility in response to pharmacological load. Cerucal increased this activity in chronics with gastroduodenitis and diabetes mellitus, pentagastrin reduced the gallbladder volume. In duodenal ulcer patients a single dose of dalargin dilated the gallbladder for a short time, while in course treatment did not influence it. Gastrocepin inhibited motor activity of gallbladder as well as corinfar.

[The status and functional characteristics of the organs of the oral cavity in children with chronic gastroduodenitis]

The status and functional characteristics of the oral cavity organs were studied in 85 children aged 7 to 12 with chronic gastroduodenitis with various gastric acid production and in 32 age-matched healthy children. Under study were mixed saliva pH values, oral mucosa temperature, Iakovets and Iasinovskiĭ's tests, nonspecific resistance of the oral mucosa, that were examined over the course of hospital treatment. The findings evidence a higher dissemination and intensity of caries, a worse status of the oral cavity, and a higher incidence of periodontitis in the children suffering from gastroduodenitis as against the reference group. The patients' salivary pH values were found changed, oral mucosa temperature and defense potential reduced, oral mucosa saturation with ascorbic acid insufficient, and leukocyte migration into the oral cavity increased.

[The effect of compensatory mechanisms of pancreatic exocrine function on the course and outcome of rehabilitative treatment in patients with chronic primary gastroduodenitis]

Methods of endogenous stimulation of the exocrinous pancreatic function in chronic primary gastroduodenitis were used. It was expressed in parallel gastric hyperchlorhydria, hyperproduction of pancreatic hydrocarbonates at initial stages of chronic primary gastroduodenitis and reduction of their excretion with diverse changes of the activity of pancreatic enzymes in prolonged and persistent course of the disease.

[Low-intensity laser treatment of patients with duodenal ulcer and erosive lesions of gastric and duodenal mucosa]

Ninety-eight patients were exposed to low-energy laser irradiation. Of these 52 and 31 had duodenal ulcer in aggravation phase with mucosal erosion and without it, respectively, 15 patients developed isolated erosive lesions of gastroduodenal mucosa. The energy was delivered to the target cites optically using fiber optics endoscope. Microcirculation was studied by bulbar biomicroscopy. Therapeutic response in the laser utilization proved positive being the highest for patients with a short disease history, moderate signs, small-size lesions. Normal microcirculation was not achieved though there was a trend to its improvement.

Patients with duodenitis have gastric secretory and motor functions like those of duodenal ulcer patients: results of a short-term treatment with ranitidine

Gastric acid secretion, gastric emptying of solids, and the effects of short-term treatment with 300 mg ranitidine at bedtime were evaluated in symptomatic patients with endoscopically and histologically proven duodenitis. The patients investigated had basal and pentagastrin-stimulated gastric acid hypersecretion, but normal gastric emptying times. Ranitidine brought about a significant improvement of endoscopic and histological features compared with the pretreatment findings. Endoscopic but not histological improvement was significantly better than with placebo. Furthermore, ranitidine brought about a significant reduction of weekly antacid consumption compared with placebo. Both ranitidine and placebo induced significant symptomatic improvement over basal conditions, but the difference between the two treatments did not reach statistical significance. Gastric secretory and motor functions, as well as the response to therapy, were similar in duodenitis patients with and without previous history of duodenal ulcer; the only exception was in antacid consumption, which was higher in the placebo group in those with past evidence of ulcer disease. Our results suggest that duodenitis patients have secretory and motor functions similar to those of duodenal ulcer patients. Therefore, further trials on large populations of duodenitis patients with antisecretory drugs are justified.

[The role of gastroduodenal diseases in the development of cardiac arrhythmia of the sick sinus syndrome type]

A total of 105 patients with suspected sick sinus syndrome were examined. All of them underwent transesophageal pacing and endoscopical investigation. A relationship is shown between lesions of the gastrointestinal tract and emergence of the sinus vagal depression leading to various disturbances of cardiac rhythm.

Abnormal small bowel permeability and duodenitis in recurrent abdominal pain

Thirty nine children with recurrent abdominal pain aged between 5.5 and 12 years, underwent endoscopic duodenal biopsy to find out if there were any duodenal inflammatory changes, and if there was a relationship between duodenal inflammation and intestinal permeability to 51Cr-EDTA. Duodenal inflammation was graded by the duodenitis scale of Whitehead et al (grade 0, 1, 2, and 3). In 13 out of 39 patients (33%) definite signs of inflammation were found (grade 2 and 3). Intestinal permeability to 51Cr-EDTA in patients with duodenitis (grade 1, 2, and 3) was significantly higher (4.42 (1.73)%) than in patients with normal (grade 0) duodenal biopsy appearances (3.3 (0.9)%). A significant association was found between duodenal inflammation and abnormal intestinal permeability. Our results give further evidence that there is an intestinal origin of these patients' complaints.

[Arterial and venous hemodynamics in peptic ulcer and the preulcerous state]

The method of tensometric universal occlusion plethysmography was used to determine the arterial and venous hemodynamics in 106 patients with ulcer disease and chronic gastroduodenitis with symptoms of ulcer disease. Reliable changes of the peripheral blood flow were revealed during exacerbations of the disease and clinico-morphological remission. The changes are caused by disorders in the system of regulation of the peripheral hemodynamics.

Clinical features of gastroduodenal Crohn's disease in adolescents

Ten cases of gastroduodenal inflammation were diagnosed by endoscopy among a series of 196 children with evidence of Crohn's disease involving other regions of the intestinal tract. Endoscopic and histologic confirmation of upper gastrointestinal tract involvement was performed only in those cases with suggestive symptoms. The mean age at presentation in the 10 cases with gastroduodenal inflammation was 14.6 +/- 1.9 (+/- SD) years, with involvement identified at the time of initial diagnosis of Crohn's disease in five of the 10. Eight of 10 cases occurred in boys. The major presenting symptoms were weight loss in five cases, epigastric pain in three, and recurrent vomiting in two. Hematemesis and melena occurred in only one of the 10 cases. Endoscopic and histological evidence of mucosal inflammation was seen in all 10 cases. Three of 10 cases had noncaseating granuloma present in biopsies of the stomach or duodenum. Two cases also had endoscopic and histological evidence of esophageal involvement. All cases were initially treated with oral corticosteroids, and in each instance a good clinical response was noted. Sucralfate (n = 1), 6-mercaptopurine (n = 1), and H2 receptor antagonists (n = 3) were used as adjunct therapy. After follow-up for 2.7 years (range, 0.5-5.5 years), none of the 10 cases required surgical intervention. Therefore, at least in the short-term, the outlook for adolescents with gastroduodenal Crohn's disease appears to be good and their medical management need not differ from those patients with Crohn's disease involving only more distal portions of the small intestine.

Interdigestive gastroduodenal motor activity in subjects with increased gastric acid secretion

The interdigestive gastroduodenal motor activity was studied in 7 patients with active duodenal ulcer and increased gastric acid secretion, in 7 patients with hypersecretory gastroduodenitis and in 7 subjects with normal acid secretion, in whom the increase in acid secretion was obtained by means of the intravenous administration of an H2 agonist, Impromidine. The gastroduodenal motor activity was recorded manometrically for about 200-300 min in basal conditions to obtain at least two subsequent activity fronts of the migrating motor complex (MMC cycle). Only in subjects with normal acid secretion was Impromidine administered at a dose of 2 micrograms/kg/h for 150 min followed by a dose of 10 micrograms/kg/h for another period of 150 min, to obtain, respectively, a submaximal and a maximal secretory response. Patients with spontaneous acid hypersecretion, with or without peptic ulcer, showed a longer than normal MMC cycle with a shorter than normal percent of time occupied by phase III. This motor activity was similar to that recorded in normal subjects during the increase in acid secretion induced by the lowest dose of Impromidine, whereas during the highest dose the gastroduodenal MMC was disrupted and replaced by an irregular motor activity.

[Impairment of the acetylating function of the liver and indicators of digestion in children with gastroduodenal and biliary pathology]

Processes of acetylation and parameters of cavitary digestion were investigated in 65 children with gastroduodenobiliary diseases. The most pronounced shifts of all the parameters studied were recorded in patients with chronic gastroduodenitis attended by metabolic dyskinesia of the biliary tract. A combination of vitamins was tested that produces protective effect on the acetylation system in the liver.

Long-term follow-up of patients with Crohn's disease. Relationship between the clinical pattern and prognosis

In a study of 615 new patients with Crohn's disease consecutively diagnosed at the Cleveland Clinic between 1966 and 1969, 592 patients were observed (mean greater than 13 yr, minimum 7 yr), giving a follow-up rate of 96.3%. The original hypothesis was that initial anatomic involvement (the clinical pattern) bears directly on clinical course and prognosis. Disease sites were as follows: 246 ileocolic, 165 small intestine, and 181 colon/anorectal. Among patients with ileocolic disease, 225 (91.5%) had surgery. For the small intestine pattern, the operative incidence was 65.5%; for the colon/anorectal pattern, it was 58%. Operations were for specific reasons: internal fistula with abscess or intestinal obstruction for ileocolic pattern; intestinal obstruction for small intestine pattern; and severe perianal disease or toxic megacolon for colon/anorectal pattern. Complications among nonoperated patients included perianal fistulas and extraintestinal manifestations. No statistical correlation existed between type and duration of medical treatment and prognosis. Seventy-five deaths occurred (12.8%), 36 of which related directly to Crohn's disease. Even after many years, symptoms continued and quality of life tended to be suboptimal among operated patients. For nonoperated patients, the most favorable quality of life was experienced by those with segmental involvement of the colon or ileum. Poor prognosis correlated with ileocolic disease and presence of sepsis because of an internal fistula.