Gastroenterology

Gastroenterology

Volume 132, Issue 2, February 2007, Pages 507-515
Gastroenterology

Clinical–alimentary tract
Low Colectomy Rates in Ulcerative Colitis in an Unselected European Cohort Followed for 10 Years

https://doi.org/10.1053/j.gastro.2006.11.015Get rights and content

Background & Aims: The colectomy rate in ulcerative colitis (UC) is related to morbidity and to treatment decisions made during disease course. The aims of this study were to determine the colectomy risk in UC in the first decade after diagnosis and to identify factors that may influence the choice of surgical treatment. Methods: In 1991-1993, 781 UC patients from 9 centers located in 7 countries in northern and southern Europe and in Israel were included in a prospective inception cohort study. After 10 years of follow-up, 617 patients had complete medical records, 73 had died, and 91 had been lost to follow-up. Results: There were no significant differences in age, sex, or disease extent at diagnosis between patients followed for 10 years and those lost to follow-up. The 10-year cumulative risk of colectomy was 8.7%: 10.4% in the northern and 3.9% in the southern European centers (P < .001). Colectomy was more likely in extensive colitis than in proctitis, with an adjusted hazard ratio (HR) of 4.1 (95% CI: 2.0–8.4). Compared with the southern centers, the adjusted HR was 2.7 (95% CI: 1.3–5.6) for The Netherlands and Norway together and 8.2 (95% CI: 3.6–18.6) for Denmark. Age at diagnosis, sex, and smoking status at diagnosis had no statistically significant influence on colectomy rates. Conclusions: The colectomy rate was found to be lower than that in previous publications, but there was a difference between northern and southern Europe. Colectomy was associated with extensive colitis, but the geographic variations could not be explained.

Section snippets

Colectomy

Status of surgery, including complications, was assessed at the 10-year follow-up visit to the local hospital by interviewing the patients and reviewing hospital records. Colectomy was classified as total abdominal colectomy (TAC) with ileostomy, total proctocolectomy (TPC) with ileostomy, proctocolectomy with ileal pouch anal anastomosis (IPAA), and other operations. Early surgery was defined as colectomy performed within the first 2 years of disease. Acute surgery was defined as colectomy

Follow-up

Nine of the 13 centers complied with the threshold limit of >60% patient identification and response, and a total of 781 patients from these centers were eligible for inclusion in the study. Of these, 690 patients (88%) were followed up for 10 years after diagnosis or until death, whichever came first. The median follow-up time was 123 months (range, 107–144). Ninety-one patients were lost to follow-up, 81 of whom were followed for varying time intervals with a median follow-up time of 46

Discussion

The overall colectomy rate in this European population-based multicenter cohort was 8.7% at 10 years. Disease extent and residence in northern Europe were identified as independent risk factors.

The strengths of the study design are the short inclusion period of only 2 years; the well-defined geographic areas, across Europe and including Israel; the uniform diagnostic criteria; and the inclusion of patients at inception on a population basis. All the patients were followed up during the same

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    Supported by the European Commission (QLG4-CT-2000-01414).

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