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 27 May 2018

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Proximal disease extension in limited ulcerative colitis

The most recent issue of the Alimentary Pharmacology & Therapeutics reviews extension of ulcerative colitis to determine frequency of disease extension in patients with limited ulcerative colitis at diagnosis.

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Disease extent in ulcerative colitis is one of the major factors determining prognosis over the long-term. 

Disease extent is dynamic and a proportion of patients presenting with limited disease progress to more extensive forms of disease over time.

Dr Colombel and colleagues from New York, USA performed a systematic review and meta-analysis of epidemiological studies reporting on extension of ulcerative colitis to determine frequency of disease extension in patients with limited ulcerative colitis at diagnosis.

The researchers performed a systematic literature search to identify studies on disease extension of ulcerative colitis and predictors of disease progression.

Extension was 18% from disease limited to the rectum to extension beyond the splenic flexure
Alimentary Pharmacology & Therapeutics
Overall, 41 studies were eligible for systematic review but only 30 for meta-analysis. 

The team found that the overall pooled frequency of ulcerative colitis extension was 23% with colonic extension being 18% at 5 years and 31% at 10 years. 

The researchers noted that extension was 18% from disease limited to the rectum to extension beyond the splenic flexure, 28% from involvement up to the splenic flexure to extension beyond the splenic flexure and 21% from disease limited to the rectum to involvement up to the splenic flexure. 

The team observed that the rate of extension was significantly higher in patients younger than 18 years compared to older patients. 

Risk of extension was significantly higher in patients from North America than from Europe.

Dr Colombel's team concluded, "In this meta-analysis, approximately one quarter of patients with limited ulcerative colitis extend over time with most extension occurring during the first 10 years."

"Rate of extension depends on age at diagnosis and geographic origin."

"Predicting those at high risk of disease extension from diagnosis could lead to personalized therapeutic strategies."

Aliment Pharmacol Ther 2017: 45(12): 1481–1492
22 May 2017

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