Risk Factors and Indications for Colectomy in Ulcerative Colitis Patients are Different According to Patient's Clinical Background

Kuriyama, Motoaki; Kato, Jun; Fujimoto, Tsuyoshi; Nasu, Junichirou; Miyaike, Jiro; Morita, Terumasa; Okada, Hiroyuki; Suzuki, Seiyuu; Shiode, Junji; Yamamoto, Hiroshi; Shiratori, Yasushi

doi:10.1007/s10350-006-0574-6

Cited by 30 publications

(22 citation statements)

References 26 publications

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“…While this is in agreement with one large scale multivariate analysis,17 multiple studies have suggested pancolitis to be a strong predictor of colectomy 10,11,18,19. It also has been clearly demonstrated that patients with pancolitis have a higher rate of dysplasia and colorectal cancer 20.…”

Section: Discussionsupporting

confidence: 88%

Severity of Inflammation as a Predictor of Colectomy in Patients With Chronic Ulcerative Colitis

Hefti

Chessin

Harpaz

et al. 2009

Diseases of the Colon &Amp; Rectum

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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 fourpoint 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 followup was low (<1 percent per year). KeywordsUlcerative colitis; Colectomy; Dysplasia; Inflammation Colon resection is a common outcome in patients with ulcerative colitis (UC). Overall, 30 percent of patients diagnosed with UC will at some point undergo colectomy-a rate that has not changed significantly during the last 50 years. 1,2 Importantly, resection of the colon and rectum, with or without creation of an ileal pouch as a neorectum, can have significant morbidity. Therefore, identification of patients with UC who will ultimately require colectomy is of great clinical value, in that this knowledge may spare some patients the complications of prolonged medical management while avoiding premature or unnecessary surgery in others. NIH-PA Author ManuscriptThere is considerable literature about factors that predict urgent or emergent colectomy in patients with acute UC flares. Lack of response to steroids, continued diarrhea and bloody bowel movements, and persistently elevated inflammatory markers all have been shown to predict colectomy in hospitalized patients with UC. [3][4][5][6] However, there are few data concerning predictive factors for colectomy in patients with longstanding disease. 7 There is broad agreement in most studies that patients with pancolitis at diagnosis are more likely to require colectomy than those with more limited disease. [8][9][10][11] Various genetic markers, including certain HLA haplotypes, also have been shown to contribute to increased risk of colectomy. [12][13][14] Evidence for other potential predictive factors, such as malnutrition, inability to wean steroids, or...

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Section: Discussionsupporting

confidence: 88%

Severity of Inflammation as a Predictor of Colectomy in Patients With Chronic Ulcerative Colitis

Hefti

Chessin

Harpaz

et al. 2009

Diseases of the Colon &Amp; Rectum

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“…Although the observed prevalence fits within the previously reported range, it was quite low compared to that observed in Western countries [10,17,21] and is closer to the results of studies initiated in Asian countries [20,22]. Differences in clinical patterns of UC between races or ethnic groups may help us to understand the etiology or pathogenesis of the disease.…”

Section: Discussionsupporting

confidence: 81%

“…The exact mechanism by which hormonal fluctuations affect the degree of inflammation and symptoms in IBD has yet to be fully identified, but investigation at the cellular level has demonstrated an effect of estrogen in the control of pathogenic inflammation [35]. In contrast, according to a report in Japan [17], one of the predictors of colectomy was the male gender, which suggests that male patients are likely to be more resistant to medical treatment or have more aggressive clinical manifestations. Regardless, the effects of gender or sex hormones on disease course and prognosis are still unclear, and further investigations are needed to clarify these points.…”

Section: Discussionmentioning

confidence: 92%

“…However, some are resistant to these therapies and require surgical treatment, such as colectomy. Recently, total proctocolectomy with ileal pouch-anal anastomosis became the preferred surgical procedure for UC patients [17]. A total of 15 subjects (3%, male:female ratio, 8:7) underwent colectomy.…”

Section: Clinical Findings At Diagnosis According To Panca Expressionmentioning

confidence: 99%

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The Prevalence and Clinical Significance of Perinuclear Anti-neutrophil Cytoplasmic Antibody in Korean Patients with Ulcerative Colitis

et al. 2009

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Perinuclear anti-neutrophil cytoplasmic antibody (pANCA) is a serological marker associated with various immune-mediated diseases whose clinical significance and possible diagnostic roles in ulcerative colitis (UC) are still unclear. We aimed to evaluate the prevalence of pANCA expression and its association with clinical findings and disease course in Korean patients with UC. This study included 484 patients with UC who were diagnosed and treated between 1990 and 2006 at Severance Hospital, Yonsei University, Seoul, Korea, and were followed for at least 1 year. Clinical findings at diagnosis, disease extent, treatment modalities used, and cumulative relapse rates were analyzed and compared to pANCA expression. Of the 484 patients, 405 (83.7%) were evaluated for pANCA and were eligible for analysis. The overall pANCA prevalence was 22.1%, with a female preponderance (male, 21.5%; female, 31.6%; P < 0.05). Proctitis was more common in pANCA-negative patients (pANCA-negative, 37.6%; pANCA-positive, 25.2%, P < 0.05). UC activity index and cumulative relapse rates were higher in pANCA-positive patients. However, there were no significant differences in the cumulative probability of steroid and immunosuppressant use and operation rate between the two groups. The prevalence of pANCA expression in Korean patients with UC was relatively low compared to that in Western countries. Although UC patients with pANCA expression had more severe clinical findings at diagnosis and higher cumulative relapse rates in our study, further prospective studies are warranted to clarify whether pANCA positivity influences the initial clinical presentation or disease aggressiveness.

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“…Total proctocolectomy is the procedure of choice for patients with MUC especially in the elective setting. A three-stage operation might be necessary if the risk for postoperative anastomotic leak is high [24]. Thus, not surprisingly, the second most common surgery in the series was restorative proctocolectomy with ileal pouch-anal anastomosis.…”

Section: Discussionmentioning

confidence: 96%

Laparoscopic surgery for inflammatory bowel disease: does weight matter?

et al. 2010

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Risk Factors and Indications for Colectomy in Ulcerative Colitis Patients are Different According to Patient's Clinical Background

Abstract: In ulcerative colitis patients, the risk factors and indications for colectomy were different according to the patient's clinical background. Our findings may help to predict patients with ulcerative colitis who have a high risk for colectomy.

Cited by 30 publications

References 26 publications

Severity of Inflammation as a Predictor of Colectomy in Patients With Chronic Ulcerative Colitis

Severity of Inflammation as a Predictor of Colectomy in Patients With Chronic Ulcerative Colitis

The Prevalence and Clinical Significance of Perinuclear Anti-neutrophil Cytoplasmic Antibody in Korean Patients with Ulcerative Colitis

Laparoscopic surgery for inflammatory bowel disease: does weight matter?

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