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Natural History of Adult Ulcerative Colitis in Population-based Cohorts: A Systematic Review

Abstract : BACKGROUND & AIMS: 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. We systematically reviewed the natural history of UC in adult population-based cohort studies with long-term follow-up. METHODS: Through a systematic literature review of MEDLINE through March 31, 2016, we identified 60 studies performed in 17 population-based inception cohorts reporting the long-term course and outcomes of adult-onset UC (n = 15,316 UC patients). RESULTS: Left-sided colitis is the most frequent location, and disease extension is observed in 10%-30% of patients. Majority of patients have a mild-moderate course, which is most active at diagnosis and then in varying periods of remission or mild activity; 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 similar to 50%. The 5-year and 10-year cumulative risk of colectomy is 10%-15%; achieving mucosal healing is associated with lower risk of colectomy. About 50% of patients receive corticosteroids, although this proportion has decreased over time, with a corresponding increase in the use of immunomodulators (20%) and anti-tumor necrosis factor (5%-10%). 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. CONCLUSIONS: 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.
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Soumis le : mercredi 2 février 2022 - 11:49:14
Dernière modification le : mardi 29 novembre 2022 - 11:56:14

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Mathurin Fumery, Siddharth Singh, Parambir S. Dulai, Corinne Gower-Rousseau, Laurent Peyrin-Biroulet, et al.. Natural History of Adult Ulcerative Colitis in Population-based Cohorts: A Systematic Review. Clinical Gastroenterology and Hepatology, 2018, 16 (3), pp.343-356.e3. ⟨10.1016/j.cgh.2017.06.016⟩. ⟨hal-03552408⟩



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