P188. Need for colectomy in ulcerative colitis; a referral center cohort
A. Settesoldi1, N. Manetti1, S. Genise2, M. Coppola1, F. Rogai1, S. Bagnoli1, A.G. Bonanomi1, G. Vannozzi1, M. Giannotta1, C. Cenci1, A. Santini1, V. Annese1, M. Milla1, 1University Hospital Careggi, Medical and Surgical Sciences, Florence, Italy, 2Gastroenterology, Florence, Italy
Previous studies have reported colectomy rates up to 50% in Ulcerative colitis (UC), although changes in management may have influenced different figures. We sought to evaluate the incidence in colectomy in our cohort and identify risk factors associated with early colectomy (EC) and late colectomy (LC).
We retrospectively interrogated our data base of UC patients evaluating the occurrence of colectomy, subdivided into EC (within three months from diagnosis) and LC. Survival curves were created and stratified by age, gender, duration of disease, presence of extra-intestinal manifestations (EIM) and therapy, including anti-TNF-alpha agents. Cox proportional hazards modeling was used to determine predictive risk factors.
1164 patients were evaluated (654 male; M:F=1.28) with a mean age of 45 yrs (range 19–89), and mean disease duration of 25 yrs (range 1–50). The proportion of patients with extensive colitis, left-side colitis, and proctitis were 39%, 50%, and 11%, respectively. Systemic steroids, thiopurines and anti-TNF-alpha agents were reported by 53%, 29%, and 5% of patients, respectively. EIM were found in 14% of patients. Among 1164 patients, 64 (5.5%) underwent colectomy; 16 patients (25%) as EC, 12 (19%) for cancer or high grade dysplasia, and the remaining 36 patients (56%) for chronically active disease. The 5-, 10-, and 20-year actuarial risk of colectomy was 2.6%, 4%, and 5% respectively. Of note, 48 patients (75%) received a proctocolectomy with ileo-anal anastomosis, and 12 (25%) developed a chronic recurrent pouchitis. In addition, more than 80% of patients received maintenance therapy with mesalazine ≥1.6 gr/daily, and 43% of patients used combined oral and topical (1–2/week) maintenance therapy. Male sex (hazard ratio [HR] = 3.5; 95% confidence interval [CI] 1.5–5.5) and pancolitis (HR = 2.5; 95% CI 1.2–4.3) were predictive for EC, after adjustment for confounders. Age at diagnosis older than 40 yrs (HR = 2.5; 95% CI 1.4–3.8) and intolerance/inefficacy of thiopurines (HR = 3.1; 95% CI 1.4–5.1) were predictive of LC.
Colectomy was rather infrequent in our cohort, being more often performed for chronically active disease. The incidence of cancer and dysplasia was also low, probably because the extensive use and adherence to mesalazine maintenance therapy. The introduction of anti-TNF-alpha therapy in the last five years has not changed this figure so far.