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. 2017 Oct 1;11(10):1200-1204.
doi: 10.1093/ecco-jcc/jjx066.

Proximal Disease Extension in Patients With Limited Ulcerative Colitis: A Danish Population-based Inception Cohort

Johan Burisch  1 , Ryan Ungaro  2 , Ida Vind  1 , Michelle V Prosberg  1 , Flemming Bendtsen  1 , Jean-Frederic Colombel  2 , Marianne K Vester-Andersen  1   3
Affiliations

Proximal Disease Extension in Patients With Limited Ulcerative Colitis: A Danish Population-based Inception Cohort

Johan Burisch et al. J Crohns Colitis. .

Abstract

Background and aims: Disease extent in ulcerative colitis [UC] is dynamic and can progress over time. Little is known about risk factors for UC extension in the era of biologics. We investigated the risk of UC extension and subsequent risk of surgery in a Danish population-based cohort.

Methods: All incident UC cases in a strictly defined Copenhagen area between 2003 and 2004 were followed prospectively through 2011. Disease extension was defined as patients with limited UC [E1 or E2] at diagnosis having progressed from the initial extent by colonoscopy or surgery to E2 or extensive colitis [E3]. Associations between progression or colectomy and multiple covariates were analysed by Cox regression analysis.

Results: Of 300 UC patients, 220 [73%] had E1 or E2 at diagnosis. During follow-up, 50 [23%] patients with E1/E2 progressed to E3, and 22 [10%] with E1 progressed to E2. Disease extent at diagnosis was the sole predictor of extension to E3. A total of 18 [8%] patients with E1/E2 at diagnosis had a colectomy. Progression from E1/E2 to E3, female gender and a history of smoking were risk factors for colectomy.

Conclusion: After 7 years of follow-up, 33% of patients with limited UC experienced disease extension. Only extent at diagnosis was a clinical predictor for disease extension. The risk of colectomy was increased in former smokers and patients who progressed to extensive colitis. This highlights the need to prevent disease progression in patients with limited UC, and to identify new histological or molecular markers that might help stratify risks for disease progression.

Keywords: colectomy; disease extent; inception cohort; ulcerative colitis.

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Figures

Figure 1.
Figure 1.
Proportion of patients with proctitis or left-sided colitis at diagnosis progressing to extensive colitis in a Danish population-based inception cohort.
Figure 2.
Figure 2.
Proportion of patients with ulcerative colitis undergoing colectomy in a Danish population-based inception cohort.
See this image and copyright information in PMC

References

    1. Ungaro R, Mehandru S, Allen PB, Peyrin-Biroulet L, Colombel J-F. Ulcerative colitis. Lancet 2017;389:1756–70. - PMC - PubMed
    1. Silverberg MS, Satsangi J, Ahmad T, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol 2005;19Suppl A:5A–36A. - PubMed
    1. Moum B, Ekbom A, Vatn MH, et al. Clinical course during the 1st year after diagnosis in ulcerative colitis and Crohn’s disease. Results of a large, prospective population-based study in southeastern Norway, 1990–93. Scand J Gastroenterol 1997;32:1005–12. - PubMed
    1. Burisch J, Pedersen N, Cukovic-Cavka S, et al. ; EpiCom Group. Initial disease course and treatment in an inflammatory bowel disease inception cohort in Europe: the ECCO-EpiCom cohort. Inflamm Bowel Dis 2014;20:36–46. - PubMed
    1. Samuel S, Ingle SB, Dhillon S, et al. Cumulative incidence and risk factors for hospitalization and surgery in a population-based cohort of ulcerative colitis. Inflamm Bowel Dis 2013;19:1858–66. - PMC - PubMed