P175 Rates of colectomy in ulcerative colitis (UC) through time in a Latin Americans unit of inflammatory bowel disease
A. Sambuelli*1, A. Gil1, S. Negreira1, S. Goncalves1, S. Huernos1, M. Bellicoso1, P. Chavero1, P. Tirado1, A. Cabanne2
1IBD Section - Hospital Bonorino Udaondo, Medicine, Buenos Aires, Argentina, 2Hospital Bonorino Udaondo, Pathology Department, Buenos Aires, Argentina
Ulcerative colitis (UC) is a chronic relapsing disease that carries the risk of potential severe complications and disability. Ileal pouch anal anastomosis (IPAA) was postulated as a suitable curative alternative for UC, but a substantial proportion of UC present short- and long-term complications. Several factors could reduce colectomy (a rapid diagnosis, information to patients, tight control, and treatment algorithms at right time). An IBD-specific electronic system functioned as a network for a reference IBD unit, working from 1990 in Buenos Aires.
Aims: to evaluate colectomy rates of UC with disease onset in this century compared with those patients with debut during the study period (dated at time of our IBD unit creation) and to study the major demographic characteristics associated with surgery.
Data were obtained from the software created in the 1990s, with revision and additional entry. We included all UC patients assisted in our unit in such periods with available data to define colectomy prevalence (survival times) age at UC onset, disease extent, and complications. We compared by survival analysis colectomy rates of UC with disease onset from 1990–1999 with the rates of patients UC debut from 2000–2014.
We inform results (categorised in both periods) of a cohort of 1 907 UC patients (female 998 and male 909), mean age (mean ± SD) at UC debut 33.5 ± 15.2, UC extent (Montreal) E1 25.1%, E2 30.5%, and E3 44.4%. Group 1: UC onset from January 1990 to December 31, 1999, (n = 885). Group 2: from January 2000 to December 31, 2014, (n = 1 022). Mean ages of UC debut and gender were similar in both periods. Colectomy rates in the UC with onset in this century (group 2) were significant lower compared with the group 1. Cumulative probabilities of surgery at 1, 2, 3, 4, 5, 7, and 10 yr for Group 1 were 4.4%, 9.1%, 12.3%, 14.5%, 16.6%, 19.5%, 23.5%, respectively; for Group 2, 3.9%, 6.5%, 8.0%, 9.7%,11.0%, 13.1%, and 16.8% (log-rank test: p < 0.002). Prevalence of colectomy 15.9% (n = 304), Group 1 21.8%; Group 2 10.9%. Colonic involvement (E3, E2, and E1) was significant more extensive in colectomised UC (82.9%, 16.1%, and 1.0%) compared with the responsive to medical treatment (37.1%, 33.2%, and 29.7%) p < 0.001 (Chi square). Median age at UC onset was lower in the UC, requiring surgery vs the managed with medical treatment 27.5 (QR 20–41.8) vs 30.0 (QR 22–43) p < 0.012 (Kruskal–Wallis Anova test). The most frequent cause of surgery was a severe flare in hospitalised UC.
In our UC cohort, colectomy rates showed a significant decrease in the current century compared with the 1990s. Colectomised patients showed more extensive compromise and younger UC onset, confirming the relevance of opportune algorithms for control and treatment of the risk groups.