Systematic analysis of factors associated with progression and regression of ulcerative colitis in 918 patients

Safroneeva, Ekaterina; Vavricka, Stephan R.; Fournier, Nicolas; Seibold, Frank; Mottet, Christian; Nydegger, Andreas; Ezri, Jessica; Straumann, Alex; Rogler, Gerhard; Schoepfer, Alain

doi:10.1111/apt.13307

Cited by 23 publications

(12 citation statements)

References 22 publications

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“…Safroneeva and colleagues did not find an association between BMI and risk of disease extension 9 . However, in their study, rate of disease extension was compared between individuals with BMI greater than 20 to those less than 20.…”

Section: Discussionmentioning

confidence: 93%

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Clinical Predictors and Natural History of Disease Extension in Patients with Ulcerative Proctitis

Walsh

Chah

Chin

et al. 2017

Inflammatory Bowel Diseases

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Background A proportion of patients with initial presentation of ulcerative proctitis (UP) progress to more extensive colitis. We sought to characterize the natural history and identify clinical predictors of extension in UP. Methods We performed a retrospective cohort study of participants with a new diagnosis of UP from January 2000 to December 2015. We used cox proportional hazard modeling to identify predictors of disease extension. Results Through December of 2015, we identified 169 cases of UP with a median age of diagnosis of 40 years (range: 16–91 years) and a median follow up of 4.3 years (range: 3.3–15.1 years). 53 (31%) patients developed extension over the follow up time. Compared to non-extenders, the need for immunosuppressive or biologic therapy was significantly higher among extenders (34% vs. 2.6%, p < 0.001). In multivariable analyses, compared to UP cases with BMI < 25, the adjusted hazard ratios (aHRs) of extension were 1.75 (95% CI, 0.95 – 3.23) and 2.77 (95% CI, 1.07 – 7.14) among overweight and obese patients, respectively (Ptrend = 0.03). Similarly, patients with a history of appendectomy or endoscopic finding of moderate to severe disease had a higher risk of extension (aHR = 2.74, 95% CI 1.07 – 7.01 and 1.96, 95% CI 1.05–3.67, respectively). Conclusion In a retrospective cohort study, we show that appendectomy, BMI, and endoscopic activity at the time of diagnosis of proctitis are associated with increased risk of extension. In addition, our data suggest that extenders are more likely to require immunosuppressive or biologic therapy.

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Section: Discussionmentioning

confidence: 93%

“…In most patients with initial diagnosis of proctitis, the disease does not extend to more proximal areas of the large intestine. Specifically, prior studies suggest that only 10–30% of patients with ulcerative proctitis experience disease extension 4–9 .…”

Section: Introductionmentioning

confidence: 99%

Clinical Predictors and Natural History of Disease Extension in Patients with Ulcerative Proctitis

Walsh

Chah

Chin

et al. 2017

Inflammatory Bowel Diseases

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“…An intriguing question is what proportion of cases do not extend proximally but remain as UP over time. In an analysis from the Swiss IBD cohort study it was found that one-third of patients increased their initial disease extent over a median follow-up period of 9 years [10]. Likewise, an Italian study found that 27% of UP cases had proximal extension over a mean follow-up period of just 5 to 6 years [11].…”

Section: Course Over Timementioning

confidence: 99%

“…In the EpiCom 2010 incidence cohort 20% of UC cases in Western Europe and 22% in Eastern Europe were defined as UP at presentation (5-year follow-up data are due to be published in the next year) [9]. The most recent report was a Swiss study, which found a ratio of 4.2:3.7:2.2 for extensive UC, distal UC and UP at time of diagnosis [10]. In summary, 22% -33% of UC cases present as UP at time of disease diagnosis.…”

Section: Incidencementioning

confidence: 99%

Refractory Ulcerative Proctitis—A Brief Review

Odes¹

2016

OJGas

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“…A prospective study of Norwegian UC patients found that at the time of presentation, colitis was limited to the rectum (proctitis) in one third of patients, the colorectum distal to the splenic flexure (left-sided colitis) in another third, and the area proximal to the splenic flexure (extensive colitis) in the remaining third ( 2 ). In patients with distal colitis, inflammation progresses in 25–50% of patients, while regression is observed in about 16% of patients ( 3 , 4 ). The anatomical extent of mucosal inflammation is one of the most important factors determining disease course.…”

Section: Introductionmentioning

confidence: 99%

CD3+CD4+LAP+Foxp3-Regulatory Cells of the Colonic Lamina Propria Limit Disease Extension in Ulcerative Colitis

et al. 2018

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Background and Aims: In ulcerative colitis (UC), inflammation begins in the rectum and can extend proximally throughout the entire colon. The extension of inflammation is an important determinant of disease course, and may be limited by the action of regulatory T cells (Tregs). In this cross-sectional study, we evaluated the relationship between UC extension and the proportions of CD3+CD4+Foxp3+ and CD3+CD4+LAP+Foxp3-Tregs in the colonic lamina propria (LP) of 79 UC patients and 29 controls. The role of these cells in UC extension was also investigated in the murine oxazolone-induced colitis model.Methods: Patients: Disease extension was classified according to the Montreal classification. Where possible, endoscopic biopsies of involved and uninvolved tissue were obtained from UC patients. Mouse model: Colitis was induced by intrarectal oxazolone administration. Lamina propria mononuclear cells were isolated from patient biopsies and mouse colon tissue using enzymatic method and the percentage of CD3+CD4+Foxp3+ and CD3+CD4+LAP+Foxp3-cells evaluated by immunofluorescence. Confocal microscopy was applied for the visualization and quantification of CD4+LAP+ cells on tissue histological sections.Results: In UC patients with distal colitis the proportion of LP CD3+CD4+Foxp3+ Tregs was significantly higher in inflamed tissue than uninvolved tissue. As opposite, the proportion of LP CD3+CD4+LAP+ Tregs was significantly higher in uninvolved tissue than involved tissue. Both LP CD3+CD4+Foxp3+ and LP CD3+CD4+LAP+ Tregs proportion in involved tissue was significantly higher than in controls irrespective of the extension of inflammation. In mice with oxazolone-induced distal colitis, treatment with LAP-depleting antibody was associated with the development of extensive colitis.Conclusions: Our findings suggest that CD3+CD4+LAP+Foxp3-Tregs limit the extension of inflammatory lesions in UC patients.

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Systematic analysis of factors associated with progression and regression of ulcerative colitis in 918 patients

Abstract: SUMMARY BackgroundStudies that systematically assess change in ulcerative colitis (UC) extent over time in adult patients are scarce.

Cited by 23 publications

References 22 publications

Clinical Predictors and Natural History of Disease Extension in Patients with Ulcerative Proctitis

Clinical Predictors and Natural History of Disease Extension in Patients with Ulcerative Proctitis

Refractory Ulcerative Proctitis—A Brief Review

CD3+CD4+LAP+Foxp3-Regulatory Cells of the Colonic Lamina Propria Limit Disease Extension in Ulcerative Colitis

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