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P387 Disease course and colectomy rate in ulcerative colitis: a follow-up cohort study of a tertiary referral center in Tuscany

N. Manetti*, S. Bagnoli, F. Rogai, M. Coppola, G. Vannozzi, M. Milla, V. Annese

AOU Careggi University Hospital, Division of Gastroenterology, Florence, Italy

Background

The disease course and colectomy rate of ulcerative colitis (UC) varies largely in population-based and referral center cohorts. In addition, the impact of changing treatment paradigms with the increasing use of immunomodulators (IM) and biologics may greatly vary among community and referral centers. We retrospectively evaluated our cohort of patients with a confirmed diagnosis UC from the 1960 to 2012, in order to determine the disease course and colectomy rate, and to identify risk factors that predict the need for surgery, including the influence of medical management.

Methods

Our study identified a cohort of 1,772 UC patients (1,011 males, mean age 45 ± 17yrs) which were followed up for a mean of 11 ± 9 yrs (range 1 - 49 yrs) at the AOU Careggi University Hospital, a referral center for Tuscany.

Results

Disease extension was E1, E2, and E3 at diagnosis in 20%, 54% and 26% of patients, respectively. At final follow-up, disease extension increased in 20% of cases, and in more than half of patients with E1. Extraintestinal manifestations (EIMs) were reported by 11% of patients, while the use of systemic corticosteroids (CS), IM or anti-TNF agents was reported in 68.6%, 19.9%, and 6.4% of cases, respectively. The number of patients treated with IM or anti-TNF increased significantly in last two decades, compared to the period 1960-1990 (26.1% vs 10.4%; p<0.008). The overall colectomy rate was 5.9% (104 pts), with a Kaplan-Meyer estimation of 1.4% at one year, 7.7% at 10 years and up to 13% at 30 years of follow-up. At univariate analysis, duration of disease, EIMs and more extensive disease (E3 vs E2+E1) were more frequently associated with surgery (p=0.008). The 1-, 5- and 10-yrs colectomy rate was not significantly reduced in the last two decades. More importantly, patients treated with IM, anti-TNF or both within 3 yrs from diagnosis didn't show a different colectomy free survival compared to patients treated after 3 yrs (9 vs 10 yrs, p=0.08; 7 vs 7 yrs, p= 0.13; 10 vs 10 yrs, p=0.91, respectively [median values]). Similar results were observed also when only patients diagnosed after 2001 were included in the analysis.

Conclusion

The overall colectomy rate in our referral center cohort is rather low, and did not changed significantly in last two decades, despite a wider use of IM and/or anti-TNF. Duration of disease, disease extension and presence of EIM emerged as predictors of colectomy. In contrast, the early introduction of IM/anti-TNF therapy, within 3 yrs from diagnosis, did not influence significantly the colectomy rate.