Temporal and geographic evolution of longstanding Crohn's disease over more than 50 years.

Data on the natural history of longstanding Crohn's disease are very limited. After searching a clinical database of over 1000 patients with Crohn's disease, it was determined that eight patients (five women, three men) had disease documented for over 50 years. In spite of complex histories with either stricturing or penetrating complications, all currently have either no symptoms or minimal disease activity, often without the need for ongoing pharmacological treatment. Most significantly, their clinical courses were all characterized by prolonged asymptomatic periods, often for more than a decade, before the recurrence of symptomatic disease. Pathological findings in all patients revealed granulomatous inflammatory disease, often recurring intermittently over many decades. Moreover, the location of the findings implied that the disease has a tendency to evolve, not only in a temporal dimension, but also extending geographically within the gastrointestinal tract. These clinical and pathological features in longstanding Crohn's disease suggest that recurring or multiple discrete initiating events, rather than a single initiating event, could be involved in the etiology and pathogenesis of Crohn's disease.