Severity of Inflammation as a Predictor of Colectomy in Patients With Chronic Ulcerative Colitis
- 1 February 2009
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Diseases of the Colon & Rectum
- Vol. 52 (2), 193-197
- https://doi.org/10.1007/dcr.0b013e31819ad456
Abstract
PURPOSE: We evaluated a large cohort of patients with longstanding ulcerative colitis in a colonoscopic surveillance program to determine predictors of colectomy. METHODS: We queried a retrospective database of patients who had symptoms of ulcerative colitis for seven years or more. Histologic inflammation in biopsies was graded on a validated four-point scale: absent, mild, moderate, severe. We performed a multivariate analysis of the inflammation scores and other variables to determine predictive factors for colectomy. Patients who underwent colectomy for neoplasia were censored at the time of surgery; those who did not undergo colectomy were censored at the time of last contact. RESULTS: A total of 561 patients were evaluated, with a median follow-up of 21.4 years since disease onset. A total of 97 patients (17.3 percent) underwent surgery; 25 (4.5 percent) for reasons other than dysplasia. These 25 constitute events for this analysis. For univariate analysis, mean inflammation (P < 0.001) and steroid use (P = 0.01) were predictors of colectomy. For multivariable proportional hazards analysis, mean inflammation (P < 0.001) and steroid use (P = 0.03) were predictors of colectomy, whereas salicylate use (P = 0.007) was protective. CONCLUSIONS: Higher median inflammation scores and corticosteroid use were predictors of colectomy in this patient population. The overall rate of colectomy during a long period of follow-up was low (<1 percent per year).Keywords
This publication has 18 references indexed in Scilit:
- Histologic Inflammation Is a Risk Factor for Progression to Colorectal Neoplasia in Ulcerative Colitis: A Cohort StudyGastroenterology, 2007
- Carcinogenesis in Inflammatory Bowel DiseaseDigestive Diseases, 2007
- Changes in Clinical Characteristics, Course, and Prognosis of Inflammatory Bowel Disease during the Last 5 Decades: A Population-Based Study from Copenhagen, DenmarkInflammatory Bowel Diseases, 2007
- Low Colectomy Rates in Ulcerative Colitis in an Unselected European Cohort Followed for 10 YearsGastroenterology, 2007
- Risk Factors and Indications for Colectomy in Ulcerative Colitis Patients are Different According to Patient's Clinical BackgroundDiseases of the Colon & Rectum, 2006
- La afectación pancolónica inicial en la colitis ulcerosa predice la necesidad de colectomía: estudio poblacional basado en una cohorte incidente de pacientes en AragónGastroenterología y Hepatología, 2005
- Genetic markers in clinically well defined patients with ulcerative colitis (UC)Clinical and Experimental Immunology, 1999
- Predicting outcome in severe ulcerative colitis.Gut, 1996
- Clinical patterns, natural history, and progression of ulcerative colitisDigestive Diseases and Sciences, 1993
- Factors affecting colectomy rate in ulcerative colitis: an epidemiologic study.Gut, 1990