The Natural Course of Ulcerative Colitis : A European Population-Based Study

Abstract

Ulcerative colitis (UC) is a chronic inflammatory disease which affects a large number of patients throughout life. This population-based European-Israeli follow-up study have been addressing the outcome of the first ten years of the disease in terms of clinical relapse, colectomy and survival. A total of 781 UC patients from six European countries and Israel, with UC diagnosed between 1991 and 1993 have been studied . Factors which could influence disease outcome have been analysed.<br> The total cumulative survival rate in UC was equal to that of the background population. No excess mortality from UC or from malignant disease could be demonstrated. Deaths caused by UC were mostly related to complications to surgery. The all over cumulative colectomy rate was below 9%, and significantly higher in patients from Northern compared with Southern centres. Extensive colitis was found to be an independent risk factor for surgery. The cumulative rate of the first clinical relapse after diagnosis was 67% in ten years. The risk of relapse was related to age under 30 at diagnosis, female gender, higher level of education and smoking cessation. Patients who relapsed shortly after diagnosis had an increased risk of later recurrences. There seemed to be an association between the risk of relapse and a positive test for p-ANCA. However, the prevalence of this serologic marker was low in our cohort.<br> For the first ten years most UC patients across Europe on a population basis seem to have a benign disease course evaluated by survival, colectomy and the risk of relapse. Aggressive medication from the time-point of diagnosis should be a subject of investigation, and careful evaluation of the need for surgery could be proposed to further improve the disease prognosis. Life insurance companies should re-evaluate their policy of restrictions for UC patients.