Clinical course and predictors of total colectomy in ulcerative colitis; a referral center experience from Turkey

Abstract

Background/Aims: We aimed to describe the clinical course of Ulcerative colitis (UC) and the factors that predict the need for total colectomy in Turkish patients with severe UC receiving regular follow up. Materials and Methods: We analyzed the demographic and clinical characteristics of 612 patients with UC receiving regular follow up between 1994 and 2010 in a tertiary referral center in Ankara. Results: Men accounted for 58% of patients (M:F ratio, 1.4:1), and the mean age at diagnosis was 37.9 years. Of these, 32% had distal colitis and 8.8% had further extension, and 39 patients (6.4%) had chronic active disease. Steroid dependency and steroid resistance rates were 7.5% and 17.2%, respectively. In multivariate analysis, steroid dependency (p=0.04), steroid resistance (p=0.002), further extension (p<0.001), presence of extensive disease (p=0.006), and chronic active disease (p<0.001) were independent predictors of the need for total colectomy. Patients with chronic active disease had lower total colectomy free survival (p<0.001). Conclusion: The predictors of total colectomy were comparable with those previously reported in the literature. However, we identified further extension in disease localization to predict the need for total colectomy.

Systematic review with meta‐analysis: proximal disease extension in limited ulcerative colitis

“…After exclusion of duplicates, 4443 records were screened. After reviewing the title and abstract and if necessary the full publications, 41 relevant studies were retrieved for full review out of 139 full‐text articles were assessed for eligibility. Studies with no baseline endoscopic assessment, less than 13 cases or with insufficient information on patients were excluded.…”

“…Twenty‐four studies were from Europe, seven from North America, seven from Asia and one from Africa . Accrual period for these studies, reported in 38 studies of 41 ranged from 1953 to 2016. Eighteen studies detailed patient gender with more than half of cases being male among all the 7 studies.…”

“…Ulcerative colitis overall rate of extension was reported in 30 studies with information on rate of extension from proctitis (E1) to left side colitis (E2) in 11 studies from left side colitis (E2) to pancolitis (E3) in 13 studies and from proctitis (E1) to pancolitis (E3) in 10 studies Information on extension over time (at 5 and 10 years) was reported in 11 studies, of which 3 were not included in the meta‐analysis because of insufficient information.…”

“…Treatments prior to extension were reported in 15 studies with use of steroids in 13 studies . EIMs were reported in seven studies and tobacco usage in 12 studies . Age at diagnosis was reported in 20 studies with a median age of 37.1 years (10.6‐69).…”

“…EIMs were reported in seven studies and tobacco usage in 12 studies . Age at diagnosis was reported in 20 studies with a median age of 37.1 years (10.6‐69).…”