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P695 The risk of proximal disease extension in patients with limited ulcerative colitis in a prospective European population-based inception cohort – the ECCO-EpiCom cohort

Burisch J.*1, Halfvarson J.2, Kupcinskas L.3, Hernandez V.4, Kaimakliotis I.5, Valpiani D.6, Pedersen N.7, Duricova D.8, Kievit L.9, Dahlerup J.F.10, Fumery M.11, Salupere R.12, Arebi N.13, Nielsen K.R.14, Giannotta M.15, Oksanen P.16, Katsanos K.H.17, Vegh Z.18, Ellul P.19, Schwartz D.20, Čuković-Čavka S.21, D'Incà R.22, Turcan S.23, Magro F.24,25,26, Goldis A.27, Langholz E.28, Lakatos P.L.18, Munkholm P.1 EpiCom Study Group

1North Zealand University Hospital, Department of Gastroenterology, Frederikssund, Denmark 2Faculty of Medicine and Health, Örebro University, Department of Gastronterology, Örebro, Sweden 3Lithuanian University of Health Sciences, Institute for Digestive Research, Kaunas, Lithuania 4Complexo Hospitalario Universitario de Vigo, Gastroenterology Department, Vigo, Spain 5Nicosia Private practice, Nicosia Private practice, Nicosia, Cyprus 6Department of Gastroenterology and Digestive Endoscopy, Morgagni Hospital, Forli, Italy 7Slagelse Hospital, Department of Gastroenterology, Slagelse, Denmark 8Charles University, IBD Center ISCARE, Prague, Czech Republic 9Herning Central Hospital, Department of medicine, Herning, Denmark 10Aarhus University Hospital, Department of Hepatology and Gastroenterology, Aarhus, Denmark 11Amiens University and Hospital, Epimad Registry, Gastroenterology Unit, Amiens, France 12Tartu University Hospital, Division of Endocrinology and Gastroenterology, Tartu, Estonia 13St Mark's Hospital, Gastroenterology, London, United Kingdom 14The National Hospital of the Faroe Islands, Medical department, Tόrshavn, Faroe Islands 15AOU Careggi Regional Referral Center for Inflammatory Bowel Disease, Gastroenterology Department, Florence, Italy 16Tampere University Hospital, Department of Gastroenterology and Alimentary Tract Surgery, Tampere, Finland 17University Hospital, Ioannina, 1st Division of Internal Medicine and Hepato-Gastroenterology Unit, Ioannina, Greece 18Semmelweis University, 1st Department of Medicine, Budapest, Hungary 19Mater Dei Hospital, Division of Gastroenterology, L-Imsida, Malta 20Soroka Medical Center and Ben Gurion University of the Negev, Department of Gastroenterology and Hepatology, Beer Sheva, Israel 21University Hospital Center Zagreb, University of Zagreb School of Medicine, Division of Gastroenterology and Hepatology, Zagreb, Croatia 22Azienda Ospedaliera di Padova, Department of Surgery, Oncology and Gastroenterology, Padova, Italy 23State University of Medicine and Pharmacy of the Republic of Moldova, Department of Gastroenterology, Chisinau, Moldova, Republic of 24University of Porto, Institute for molecular and cell biology, Porto, Portugal 25Hospital de São João, Department of Gastroenterology, Porto, Portugal 26Oporto Medical School, Institute of Pharmacology and Therapeutics, Porto, Portugal 27University of Medicine “Victor Babes”, Clinic of Gastroenterology, Timisoara, Romania 28Gentofte Hospital, Department of Medical Gastroenterology, Copenhagen, Denmark

Background

Ulcerative colitis (UC) is a progressive and dynamic disease and many patients will experience an extension of inflammation from their initial disease location. Disease extent is the most important factor determining disease prognosis over the long-term. As only few population-based studies have investigated the disease extension and subsequent risk of surgery in UC, we sought to investigate this in the European population-based EpiCom-cohort.

Methods

The EpiCom-cohort is a population-based cohort of unselected patients with inflammatory bowel disease diagnosed in 2010 in Eastern and Western European centres. Patients were followed prospectively for five years and clinical data were captured throughout the follow-up period and entered in a validated web-based database. Disease extension was defined in patients with limited UC at diagnosis (proctitis, E1 or left-sided, E2) as a progression from the initial extent defined by endoscopy or surgery. The risk of colectomy was assessed in all incident patients. Associations between progression or colectomy and multiple covariates (age, gender, initial disease extent, diagnostic delay, smoking status, increase in extent, geographic region) were analysed by Cox regression analyses using the proportional hazard assumption.

Results

A total of 614 incident UC patients were included in the study, of which 390 (64%) had E1 or E2 at diagnosis. Extent at diagnosis and during follow-up is shown in Table 1. During the follow-up period, 68 (18%) patients with E1/E2 progressed to E3, and 20 (5%) patients with E1 progressed to E2. No clinical predictors of extension to either E2 or E3 were identified. During follow-up, a total of 35 (6%) patients had a colectomy. Of patients with E1/E2 as initial extent a total of 18 (5%) patients had a colectomy. Progression from E1/E2 to E3 or from E1 to E2 was a significant risk factor for colectomy (HR 7.4 CI95%: 2.7–20.2). No difference in the results was found between Eastern and Western European patients.

Table 1. Disease extent in ulcerative colitis patients at diagnosis and follow-up

At diagnosisAt follow-upTotal (diagnosis)
E1 (proctitis)E2 (left-sided)E3 (extensive)
E1 (proctitis)96 (25%)20 (5%)18 (4%)134 (34%)
E2 (left-sided)206 (53%)50 (13%)256 (66%)
Total (follow-up)96 (25%)226 (58%)68 (17%)390 (100%)

Conclusion

In this European population-based inception cohort of unselected UC patients one out of four patients with proctitis or left-sided colitis at diagnosis experienced a progression in disease extent after five years of follow-up. The risk of colectomy was increased in patients who progressed to either left-sided or extensive colitis. No clinical predictors for disease extension could be identified, thus highlighting the need for new histological or serological markers in order to identify patients at risk for disease progression.