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
- surgery for IBD
- IBD clinical
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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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