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Sixty-four black patients with inflammatory bowel disease (IBD) were seen from 1960 to 1987 at the Medical College of Georgia, representing 22% of all patients with IBD: 38 of them had Crohn's disease (CD) and 26 had ulcerative colitis (UC). In those with CD, the small intestine alone was involved in 16% and ileocolitis was found in 58%; joint disease affected 11 patients (29%) and perianal disease 13 patients (34%). Twenty black patients (53%) underwent one disease-related surgical procedure, and 10 (50%) of those required two or more reoperations. Nine UC patients (35%) underwent surgery, and, except for three cases of sclerosing cholangitis (12%), black patients with UC showed no clinical findings different from white UC patients. In our American black patients, the course of IBD was similar to that of white patients, although in Crohn's disease the reoperation rate and the rate of joint involvement were higher in our black IBD patients; primary sclerosing cholangitis was also found in a larger percentage of black patients with UC than in our white patient population.