Thesis (MHSc--Health Science) -- Auckland University of Technology, 2005. / Also held in print (viii, 66 leaves ; 30 cm.) in Akoranga Theses Collection. (T 616.34409 LYN)

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The fact therefore remains that, at the present time, Crohn's disease is still an enigma. The aetiology and pathogenesis are obscure, the clinical findings and progression of the disease are unpredictable and the histological findings are often nonspecific. With this in mind, this dissertation attempts to define and document the incidence of certain histological features at presentation in a population of Crohn's disease patients from Groote Schuur Hospital. The main aim is to determine the incidence of granulomas in the study group as a whole, as well as to establish the distribution of granulomas within the bowel. A correlation between the presence of granulomas and the clinical activity of the disease (as assessed by the Crohn's Disease Activity Index) is also sought.

Both ulcerative colitis and Crohn's disease are chronic disorders of unknown aetiology. The purpose of this study was to map the incidence and current natural history of both diseases so that this knowledge might assist in the better management of patients. The study is of a cohort of 723 patients with inflammatory bowel disease diagnosed in Wolverhampton, Salisbury and Swindon between 1977-86 and followed up prospectively until 31st December 1993. The incidence, mortality, survival and short-term prognosis in relation to age, sex, length of history, severity and extent of disease were analysed. The long-term prognosis was examined in relation to the course, relapses, recurrence, surgical treatment, remote complications and cancer risk. No increase in the incidence of ulcerative colitis and Crohn's disease was found. The age distribution of both diseases showed a bimodal pattern with peaks at 20-39 and 50-69. The incidence of ulcerative colitis was highest in Wolverhampton as was the incidence of Crohn's disease in Swindon. It was similar between men and women. The Standardised Mortality Ratio (~MR) of ulcerative colitis and Crohn's disease was similar to the general population, except that it was significantly higher in Swindon. The excess death was not from ulcerative colitis. Ulcerative colitis: Rank correlation analysis showed length of history, extent and severity of disease were strongly associated with prognosis of first attack. There was also a strong inter-relationship between these factors. 80% of patients were in remission at any time but at 15 years 72% had experienced at least one relapse and 15% of patients had undergone colectomy. The severity and extent of disease at first attack was found to be predictive of colectomy. The prognosis was different in Wolverhampton. More patients underwent surgery and colectomy. When the influence of race was considered South Asian patients presented with more severe and extensive colitis and they were younger than white patients. The relapse and colectomy rate were greater in South Asians during follow up. The racial differences in incidence, course and prognosis of ulcerative colitis needs further investigations. The lower incidence in Swindon, less common extensive colitis both at presentation and during follow up, and lower colectomy rate might suggest a milder form of ulcerative colitis. Crohn's disease: Rank correlation analysis showed age, site of disease and length of history were not associated with short term prognosis. Almost 80% of patients were in remission at any time and 84% experienced at least one relapse in 14 years which required treatment. The relapse rate in Swindon was higher but were mostly treated medically.47% of patients had undergone some form of intestinal resection in 14 years, 33% required a second operation within 10 years. This study failed to show any relationship between the first recurrence and age at diagnosis, length of history or initial site of involvement. The prognosis was different in Wolverhampton; more patients underwent intestinal resection. In Wolverhampton there were significantly more patients with anal Crohn's and 38% of these patients who underwent surgery did so because of anal Crohn's. There was a improvement in the prognosis of VC and CD in the present study in comparison to the studies in the last few decades. The apparent improvement of outcome may result from changing criteria and speed of diagnosis, the introduction of new treatments and their rapid application. The need exists for new and improved treatment for those patients who do not currently respond adequately. Outcome measurements suggest that most, but not all patients, with ulcerative colitis and Crohn's disease lead a relatively normal social and working life. The results may be of value for reassessing the life insurance risk of patients with inflammatory bowel disease. The results suggest there is a need for further reallocation of resources for both research and health care delivery to these patients.

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