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P063. Disease extension is the major factor affecting the disease course of ulcerative colitis (UC)

M. Cappello, S. Peralta, M. Mazza, I. Bravatà, A. Craxì, P.L. Almasio

University of Palermo, Palermo, Italy

Background and Aim: Most information on the course of UC derives from studies in Northern European and USA cohorts. We reassessed disease behaviour and outcome in an ethnically homogeneous cohort of Sicilian patients with UC to identify factors associated with a worse prognosis in this population.

Materials and Methods: Between January 2009 and June 2010 204 patients with a diagnosis of UC (ECCO criteria; 121 males; mean age 38.9 years, range 10–80) were recruited at our tertiary referral unit. Data regarding age, sex, familial history of IBD, smoking, appendectomy, extra-intestinal manifestations, disease localization, clinical presentation, surgery, use of steroids or any major drugs were collected in a dedicated database at the time of diagnosis and during follow-up. Kaplan–Meier survival curves were plotted to assess the incidence of relevant events during the observation period.

Result: Median follow-up time was 9 years. At the onset of the disease, the affected site was: proctitis or proctosigmoiditis in 114 patients (55.9%), left-sided colitis in 41 (20.1%), pancolitis in 39 (19.1%). The site of disease was unknown in 4.9%. Steroids were started at the time of first attack in 114 patients. Proximal disease extension was observed in 21 (18.4%) patients with proctosigmoiditis and in 6 (14.6%) patients with left-sided colitis. Extension was associated with male sex (p = 0.014) and with use of steroids at the time of diagnosis (p = 0.004), in the first group, and only with use of steroids at the time of diagnosis (p = 0.06) in the latter. Proximal progression was observed at endoscopy more frequently among younger patients in this group. Extra-intestinal manifestations were associated to a worse course of UC, with a lower rate of patients without intestinal symptoms at the end of follow-up (from 90.5% to 80.7%). Disease extension at time of diagnosis (p = 0.007) and early use of steroids (p = 0.016) were also related to the need for use of immunosuppressant or biological drugs. The overall rate of surgery was 4.8% at the end of follow-up. In five patients surgery was necessary at the time of diagnosis for a severe clinical presentation refractory to steroids. There were no deaths. Only one subject developed a colorectal cancer.

Conclusions: Our study confirms that UC in Southern Europe has a relatively indolent course. Disease extension and use of steroids at the time of diagnosis were related to the need for major drugs because of a more aggressive disease. This subgroup of patients could hence deserve a “top-down” strategy with an earlier use of immunomodulators and biological agents.