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P246 Long-term prognosis of ulcerative colitis and its temporal changes between 1986 and 2015 in a population-based cohort in the Songpa-Kangdong district of Seoul, Korea

J.M. Cha1, S.H. Park2, K.H. Rhee3, S.N. Hong4, Y.H. Kim4, S.I. Seo5, K.H. Kim5, S.K. Jeong6, J.H. Lee7, S.Y. Park8, H. Park9, J.S. Kim10, J.P. Im10, H. Yoon11, S.H. Kim12, J. Jang12, J.H. Kim13, S.O. Suh14, Y.K. Kim15, Y.J. Kim16, B.D. Ye2, S.K. Yang2, the Songpa-Kangdong Inflammatory Bowel Disease (SK-IBD) Study Group

1Kyung Hee University Hospital at Gang Dong, Kyung Hee University College of Medicine, Department of Internal Medicine, Seoul, Korea Republic of, 2Asan Medical Center- University of Ulsan College of Medicine, Department of Gastroenterology, Seoul, Korea- Republic Of, 3Hansol Hospital, Department of Internal Medicine, Seoul, Korea- Republic Of, 4Samsung Medical Center- Sungkyunkwan University School of Medicine, Department of Medicine, Seoul, Korea Republic of, 5Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Department of Internal Medicine, Seoul, Korea Republic of, 6Yang Hospital, Department of Surgery, Seoul, Korea- Republic of, 7Seoul Song Do Colorectal Hospital, Digestive Endoscopic Center, Seoul, Korea Republic of, 8Kangdong Seoul Colon and Rectal Surgery, Surgery, Seoul, Korea Republic of, 9Daehang Hospital, Department of Gastroenterology-, Seoul, Korea Republic of, 10Seoul National University College of Medicine, Department of Internal Medicine and Liver Research Institute, Seoul, Korea- Republic of, 11Seoul National University Bundang Hospital, Department of Internal Medicine, Seongnam, Korea Republic of, 12VHS Medical Center, Department of Internal Medicine, Seoul, Korea Republic of, 13Konkuk University School of Medicine- Konkuk University Medical Center, Department of Internal Medicine, Seoul, Korea Republic of, 14National Police Hospital, Department of Internal Medicine, Seoul, Korea Republic of, 15Jamsil Seoul Surgical Clinic, Surgery, Seoul, Korea- Republic of, 16Asan Medical Center- University of Ulsan College of Medicine, Department of Clinical Epidemiology and Biostatistics, Seoul, Korea Republic of

Background

No population-based study has evaluated the natural course of ulcerative colitis (UC) over three decades in non-Caucasians. We aimed to assess the long-term natural course of Korean patients with UC in a population-based cohort.

Methods

This Korean population-based SK-IBD cohort included all patients (N = 1013) newly diagnosed with UC during 1986–2015. Disease outcomes and their predictors were evaluated.

Results

During the median follow-up of 105 months, the overall use of systemic corticosteroids, thiopurines, and anti-tumour necrosis factor (TNF) agents was 40.8%, 13.9%, and 6.5%, respectively. Over time, the cumulative risk of commencing corticosteroids decreased, whereas that of commencing thiopurines and anti-TNF agents increased. During follow-up, 28.7% of 778 patients with proctitis or left-sided colitis at diagnosis experienced proximal disease extension. A total of 28 patients (2.8%) underwent colectomy, demonstrating cumulative risks of colectomy at 1, 5, 10, 20, and 30 years after diagnosis of 1.0%, 1.9%, 2.2%, 5.1%, and 6.4%, respectively. Multivariate Cox regression analysis revealed that extensive colitis at diagnosis (hazard ratio [HR] 8.249, 95% confidence interval [CI] 2.394–28.430), ever use of corticosteroids (HR 6.437, 95% CI 1.440–28.773), and diagnosis in the anti-TNF era (HR 0.224, 95% CI 0.057–0.886) were independent predictors of colectomy. The standardised mortality ratio in UC patients was 0.725 (95% CI 0.508–1.004).

Conclusion

Korean UC patients may have a better clinical course than Western patients, as indicated by a lower colectomy rate. The overall colectomy rate has continued to decrease over the past three decades.