Long-term Prognosis of Ulcerative Colitis and its Temporal Change Between 1977 and 2013: A Hospital-based Cohort Study from Korea

• Published in: Journal of Crohn's and colitis Vol. 9; no. 2; pp. 147 - 155
• Main Authors: Lee, Ho-Su, Park, Sang Hyoung, Yang, Suk-Kyun, Lee, Jungbok, Soh, Jae Seung, Lee, Seohyun, Bae, Jung Ho, Lee, Hyo Jeong, Yang, Dong-Hoon, Kim, Kyung-Jo, Ye, Byong Duk, Byeon, Jeong-Sik, Myung, Seung-Jae, Yoon, Yong Sik, Yu, Chang Sik, Kim, Jin-Ho
• Format: Journal Article
• Language: English
• Published: UK Oxford University Press 01.02.2015
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Child; Colectomy - methods; Colitis, Ulcerative - diagnosis; Colitis, Ulcerative - epidemiology; Colitis, Ulcerative - therapy; Disease Management; Disease Progression; Female; Follow-Up Studies; Forecasting; Hospitals, University - statistics & numerical data; Humans; Immunosuppressive Agents - therapeutic use; Male; Middle Aged; Morbidity - trends; Prognosis; Republic of Korea - epidemiology; Retrospective Studies; Risk Factors; Severity of Illness Index; Time Factors; Young Adult; Republic of Korea; colectomy; Clinical features; ulcerative colitis; prognosis; Korea
• ISSN: 1873-9946; 1876-4479; 1876-4479
• DOI: 10.1093/ecco-jcc/jju017

Background and aims: No previous large-scale studies have evaluated the prognosis of ulcerative colitis (UC) over a period of three decades in a non-Caucasian population. The aims of this study were to update the current information on the natural course of UC in a sizable cohort of Korean patients and to evaluate changes in the treatment paradigms and prognosis of UC over time. Methods: We retrospectively analyzed 2802 Korean UC patients who visited Asan Medical Center. We divided the study subjects into three groups based on the year of diagnosis (cohort 1: 1977–1999; cohort 2: 2000–2006; and cohort 3: 2007–2013). Results: Five-year cumulative probabilities of prescription of thiopurines (azathioprine or 6-mercaptopurine) and anti-tumor necrosis factor (anti-TNF) agents were 4.1% and 0.0%, respectively, in cohort 1 and 27.9% and 12.7%, respectively, in cohort 3 (P < 0.001). A total of 209 patients (7.5%) underwent colectomy, producing cumulative probabilities of colectomy at 10, 20 and 30 years after diagnosis of 7.8%, 14.2% and 21.3%, respectively. The cumulative probability of colectomy was especially low in patients first diagnosed at our center: 3.1% at 10 years and 4.5% at 20 years. Moreover, the cumulative probability of colectomy decreased significantly over the last 30 years (P = 0.039). Conclusion: Thiopurines and anti-TNF agents are used increasingly more frequently and earlier, while the colectomy rate has decreased over the last 30 years in Korean patients with UC. Korean UC patients may have a better clinical course than Western cases, as indicated by a lower colectomy rate.