A comprehensive knowledge of the natural history of ulcerative colitis (UC) helps understand disease evolution, identify poor prognostic markers and impact of treatment strategies, and facilitates shared decision-making.
Dr Mathurin Fumery and colleagues from France systematically reviewed the natural history of UC in adult population-based cohort studies with long-term follow-up.
Through a systematic literature review of MEDLINE through March 31, 2016, the team identified 60 studies performed in 17 population-based inception cohorts reporting the long-term course and outcomes of adult-onset UC.
Left-sided colitis is the most frequent location, and disease extension is observed in 10%–30% of patients.
|Almost 50% of patients require UC-related hospitalization|
|Clinical Gastroenterology & Hepatology|
Majority of patients have a mild-moderate course, which is most active at diagnosis and then in varying periods of remission or mild activity.
The team found that about 10%–15% of patients experience an aggressive course, and the cumulative risk of relapse is 70%–80% at 10 years.
Almost 50% of patients require UC-related hospitalization, and 5-year risk of re-hospitalization is ∼50%.
The researchers found that the 5-year and 10-year cumulative risk of colectomy is 10%–15%, achieving mucosal healing is associated with lower risk of colectomy.
The team observed that about 50% of patients receive corticosteroids, although this proportion has decreased over time, with a corresponding increase in the use of immunomodulators and anti–tumor necrosis factor.
Although UC is not associated with an increased risk of mortality, it is associated with high morbidity and work disability, comparable to Crohn’s disease.
Dr Fumery's team concludes, "UC is a disabling condition over time."
"Prospective cohorts are needed to evaluate the impact of recent strategies of early use of disease-modifying therapies and treat-to-target approach with immunomodulators and biologics."
"Long-term studies from low-incidence areas are also needed."