Disease Course and Colectomy Rate of Ulcerative Colitis: A Follow-up Cohort Study of a Referral Center in Tuscany

• Published in: Inflammatory bowel diseases 2016-08, Vol.22 (8), p.1945-1953
• Main Authors: Manetti, Natalia, Bagnoli, Siro, Rogai, Francesca, Bonanomi, Andrea G, Vannozzi, Giancarlo, Giannotta, Martina, Annese, Vito
• Format: Article
• Language: English
• Subjects: Adolescent; Adrenal Cortex Hormones - therapeutic use; Adult; Aged; Aged, 80 and over; Child; Cholangitis, Sclerosing - etiology; Colectomy - statistics & numerical data; Colitis, Ulcerative - complications; Colitis, Ulcerative - drug therapy; Colitis, Ulcerative - surgery; Colorectal Neoplasms - etiology; Eye Diseases - etiology; Female; Follow-Up Studies; Humans; Immunologic Factors - therapeutic use; Italy; Kaplan-Meier Estimate; Male; Middle Aged; Retrospective Studies; Risk Factors; Skin Diseases - etiology; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Young Adult
• ISSN: 1078-0998; 1536-4844
• DOI: 10.1097/MIB.0000000000000787

The disease course and colectomy rate of ulcerative colitis (UC) vary largely in population-based and referral center cohorts. We retrospectively evaluated our cohort to determine the disease course and risk factors for colectomy. A cohort of 1723 ulcerative colitis patients (986 males; mean age, 34.8 ± 15.4 yrs) were identified and followed since 1960s for a mean of 11 ± 9 years (range, 1-49 yrs). The disease extension was classified as E1, E2, and E3 on diagnosis at 19.7%, 54.2%, and 26.1% of patients, respectively. At the final follow-up, the disease extension increased in 20% of the cases. Extraintestinal manifestations (EIMs) were reported by 11% of the patients, whereas systemic corticosteroids (CS), IM or anti-TNFα agents were used by 68.6%, 20.4%, and 6.4% of patients, respectively. The crude colectomy rate was 7% (120 pts), with a 1.2% rate (n = 21) at 1 year from diagnosis (95% CI, 0.7-1.7) and a Kaplan-Meyer estimation of up to 18.2% after 30 years of follow-up. The 1-year colectomy rate showed no significant difference through the decades, whereas the 5-year and 10-year absolute value of colectomy was halved in the last 2 decades compared with the period from 1960 to 1990 (P = 0.01), with a general trend of a reduced colectomy rate at survival curves (P = 0.056). The colectomy rate was low in our cohort and further reduced in the last 2 decades. However, despite the availability of anti-TNFα agents, no further significant reduction of colectomies was observed in the last decade.