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Original article
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
  1. Jae Myung Cha1,
  2. Sang Hyoung Park2,
  3. Kyoung Hoon Rhee3,
  4. Sung Noh Hong4,
  5. Young-Ho Kim4,
  6. Seung In Seo5,
  7. Kyung Ho Kim5,
  8. Seung Kyu Jeong6,
  9. Ji Hyun Lee7,
  10. Sun Yong Park8,
  11. Hyunju Park9,
  12. Joo Sung Kim10,
  13. Jong Pil Im10,
  14. Hyuk Yoon11,
  15. Sung Hoon Kim12,
  16. Jisun Jang12,
  17. Jeong Hwan Kim13,
  18. Seong O Suh14,
  19. Young Kyun Kim15,
  20. Byong Duk Ye2,
  21. Suk-Kyun Yang2
  1. 1Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University College of Medicine, Seoul, Korea (the Republic of)
  2. 2Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
  3. 3Department of Internal Medicine, Hansol Hospital, Seoul, Korea (the Republic of)
  4. 4Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  5. 5Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea (the Republic of)
  6. 6Department of Surgery, Yang Hospital, Seoul, Korea (the Republic of)
  7. 7Digestive Endoscopic Center, Seoul Song Do Colorectal Hospital, Seoul, Korea (the Republic of)
  8. 8Kangdong Seoul Colon and Rectal Surgery, Seoul, Korea (the Republic of)
  9. 9Department of Gastroenterology, Daehang Hospital, Seoul, Korea (the Republic of)
  10. 10Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  11. 11Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea (the Republic of)
  12. 12Department of Internal Medicine, VHS Medical Center, Seoul, Korea (the Republic of)
  13. 13Department of Internal Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Korea (the Republic of)
  14. 14Department of Internal Medicine, National Police Hospital, Seoul, Korea (the Republic of)
  15. 15Jamsil Seoul Surgical Clinic, Seoul, Korea (the Republic of)
  1. Correspondence to Dr Suk-Kyun Yang, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of); sky{at}amc.seoul.kr

Abstract

Objective No population-based study has evaluated the natural course of 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.

Design This Korean population-based, Songpa-Kangdong 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 antitumour necrosis factor (anti-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 (HR 8.249, 95% CI 2.394 to 28.430), ever use of corticosteroids (HR 6.437, 95% CI 1.440 to 28.773) and diagnosis in the anti-TNF era (HR 0.224, 95% CI 0.057 to 0.886) were independent predictors of colectomy. The standardised mortality ratio in patients with UC was 0.725 (95% CI 0.508 to 1.004).

Conclusion Korean patients with UC 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.

  • ulcerative colitis
  • epidemiology
  • surgery for IBD
  • IBD clinical
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Footnotes

  • JMC, SHP and KHR contributed equally.

  • Contributors Study concept and design: JMC, SHP, KHR, BDY, SKY. Acquisition of data: SHP, KHR, Y-HK, SNH, KHK, SIS, JMC, SYP, SKJ, JHL, HP, JSK, JPI, HY, SHK, JJ, JHK, SOS, YKK, BDY, SKY. Statistical analysis and interpretation of data: JMC, SHP, BDY, SKY. Drafting of the manuscript: JMC, SHP, SKY. Critical revision of the manuscript for important intellectual content: SKY. Study supervision: SKY.

  • Funding This work was partially supported by a Korean Health Technology R&D Project grant from the Korea Health Industry Development Institute to SKY (A120176), funded by the Ministry of Health and Welfare, and by a research grant from Janssen Korea.

  • Competing interests SKY received a research grant from Janssen Korea.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the institutional review boards of all participating hospitals.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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