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Decreasing colectomy rates for ulcerative colitis

A study in December's American Journal of Gastroenterology examines population-based time trends for colectomy rates for ulcerative colitis.

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Colectomy rates for ulcerative colitis have been inconsistently reported.

Dr Gilaad Kaplan and colleagues assessed temporal trends of colectomy rates for ulcerative colitis, stratified by emergent vs. elective colectomy indication.

The team identified adults hospitalized for a flare of ulcerative colitis between 1997 and 2009.

Medical charts were reviewed.

The researchers evaluated temporal changes using linear regression models to estimate the average annual percent change in surgical rates.

Logistic regression analysis compared ulcerative colitis patients responding to medical management in hospital to those who underwent colectomy with ulcerative colitis patients who underwent an emergent vs. elective colectomy.

In addition, the team evaluated temporal trends of drug utilization.

Elective colectomy rates dropped by about 7% per annum
American Journal of Gastroenterology

The team of doctors observed that from 1997 to 2009, colectomy rates significantly dropped for elective colectomies with an average annual percent change of −7%.

The rate of emergent colectomies remained stable with an average annual percent change of about −1%.

The researchers found that azathioprine/mercaptopurine prescriptions increased from 1997 to 2009, and infliximab use increased after 2005.

The researchers observed a 13% per year risk adjusted reduction in the odds of colectomy in ulcerative colitis patients responding to medical management compared with those who required colectomy.

Emergent colectomy patients had a shorter duration of flare and underwent colectomy early after diagnosis.

Dr Kaplan's team concludes "From 1997 to 2009, use of purine anti-metabolites increased and elective colectomy rates in ulcerative colitis patients decreased significantly."

"In contrast, emergent colectomy rates were stable, which may have been due to rapid progression of disease activity."

Am J Gastroenterol 2012; 107:18791887
21 December 2012

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