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P129 Systematic evaluation of clinical predictors of aggressive ulcerative colitis

S. Vavricka1, F. Reinisch2, N. Fournier3, 4, V. Pittet3, E. Safroneeva5, M. Scharl2, P. Michetti6, G. Rogler1, A. Schoepfer*7

1University of Zurich, Gastroenterology and Hepatology, Zurich, Switzerland, 2University Hospital Zurich, Gastroenterology, Zurich, Switzerland, 3Institute of Social and Preventive Medicine, Healthcare Evaluation Unit, Lausanne, Switzerland, 4University of Lausanne, IUMSP, Lausanne, Switzerland, 5University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland, 6Crohn and Colitis Center Clinique La Source , Gastroenterology, Lausanne, Switzerland, 7Centre Hospitalier Universitaire Vaudois, Gastroenterology and Hepatology, Lausanne, Switzerland

Background

Studies evaluating risk factors associated with an "aggressive" disease course in ulcerative colitis (UC) are scarce. A recent definition of "aggressive" UC incorporated the following characteristics: 1) high relapse rate, 2) need for surgery, 3) development of colorectal cancer, and 4) presence of extraintestinal manifestations (EIM). The following factors for an aggressive / disabling disease course in UC have been identified so far: age < 40 years at UC diagnosis, pancolitis, concomitant primary sclerosing cholangitis, and deep ulcerations of the colonic mucosa. We aimed to evaluate risk factors for an "aggressive" disease course in UC patients.

Methods

Data from the Swiss IBD cohort study were analyzed. Patients were recruited from university centers (80%), regional hospitals (19%), and private practices (1%). We applied the following definition for "aggressive" UC: 1) patients ever treated with TNF-antagonists or calcineurin inhibitors (tacrolimus / cyclosporine), and 2) need for (procto)-colectomy. Non-normal data are presented as median and interquartile range [IQR].

Results

A total of 1,130 adult UC patients were included. Of these, 422 (37.3%) had an aggressive disease course. UC patients with aggressive disease course were characterized by the following features when compared to UC patients with non-aggressive disease course: more frequently males (59.2% vs. 50.6%, p = 0.005), younger at UC diagnosis (median 28 years vs. 33 years, p < 0.001), more frequently < 40 years at diagnosis (79.8% vs. 72.1%, p = 0.004), more frequently pancolitis at diagnosis (51% vs. 37.1%, p <0.001), younger age at latest follow-up (median 41 years vs. 46 years, p < 0.001), and had more frequently extraintestinal manifestations (52.6% vs. 36.3%, p < 0.001). No difference was found between the two groups when analyzing the length of diagnostic delay, body mass index, NSAID intake at symptom onset, disease duration (both median of 10 years), geographical provenience (urban vs. rural), and education level. UC patients with aggressive disease course were more frequently treated with antibiotics (40.3% vs. 18.6%, p < 0.001), with steroids (92.4% vs. 72.2%, p < 0.001), and immunomodulators (80.6% vs. 47.5%, p <0.001).

Conclusion

Our large cohort study confirmed the following risk factors for "aggressive" disease course: young age at diagnosis, extensive colitis / pancolitis at diagnosis, and presence of extraintestinal manifestations. In addition, our study identified male gender to be a risk factor for "aggressive" disease course. Further studies will have to show if early stepup therapy is beneficial in UC patients fulfilling criteria for "aggressive" disease course.