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P286 Rate of colectomy in ulcerative colitis: Results from a Spanish cohort with 15 years of follow-up

C. Rodriguez Gutiérrez1, A. Elosua Gonzalez2, C. Prieto Martínez1, S. Rubio Iturria1, M.A. Vicuña1, Ó. Nantes Castillejo1

1Complejo Hospitalario de Navarra, Gastroenterology and Hepatology, Pamplona, Spain, 2Hospital García Orcoyen, Gastroenterology and Hepatology, Estella, Spain

Background

Knowing the natural history of ulcerative colitis (UC) is essential to understand the evolution of the disease, assess the impact of different therapeutic strategies, identify poor prognostic factors and provide patients with understandable information who help them in decision making. It has been suggested that biological drugs could modify natural history of UC and therefore decrease the rates of colectomy. In Spain, infliximab is approved for CU since 2005.

Methods

We performed a retrospective study that includes all patients with a definitive diagnosis (DD) of UC or Unclassifiable Colitis (UC) in the Navarra Incident Cohort (which includes all patients diagnosed between 2001 and 2003 in Navarra, Spain). Our objectives were to analyse the Colectomy Incidence Rate (CIR) from diagnosis to the end of follow-up (12-31-2017) and identify predictive factors of colectomy.

Results

We included 174 patients with DD of UC (42.5% E2 - 26.8% E3) and 5 of IC: 44.1 women, median age 39.2 years (7–88), median follow-up of 15.7 years. At the end of the follow-up, 8 patients underwent colectomy (CIR 3 surgeries per 100000patients-year). Timing of colectomy was: 3 at the initial diagnosis (<1 month), 2 in the first 2 years, 2 at 5 years and 1 at 12 years from diagnosis. All had previously received steroids, 5 immunomodulators and 2 biological agents. In 7 (87%) the surgery was urgent and the indication, megacolon in 3 (37.5%), severe outbreak in 3 (37.5%) and failure to medical treatment in 2 (25%). In 5 cases (62.5%), an ileoanal reservoir was made and in 3 definitive ileostomy.

SexAge at diagnosis (years)ETime to colectomyUrgent/plannedIndicationProcedureYear of surgeryPrevious treatmets
1Female34E3< 1 monthurgentMegacolonPouch2001Cs
2Male51E3< 1 monthurgentMegacolonPouch2001Cs
3Female69E3< 1 monthurgentMegacolon PerforationDefinitive ileostomy2001Cs
4Female56E31,7 yearsplannedPersistent inflammatory activityDefinitive ileostomy2003Cs-CyA-AZA
5Male43E21,7 yearsurgentSevere flare (2º)Definitive ileostomy2005Cs-CyA-AZA
6Male47E24,7 yearsurgentSevere flarePouch2006Cs-CyA
7Male44E35.2 yearsurgentSevere flarePouch2008Cs-CyA-IFX (2 dosis)
8Female35E312 yearsurgentPersistent inflammatory activitypouch2015Cs-CyA-AZA-MP-MTX IFX-ADA-GMM

Cs, corticosteroids; Cs, Cyclosporin; AZA, azathioprine; MP, mercaptopurine; IFX, infliximab; ASA, Adalimumab: GMM, golimumab.

Conclusion

In our cohort, global colectomy rates are lower than those reported in other series and occur mostly in the first 5 years of evolution.