United European Gastroenterol J. 2016 Apr;4(2):281-7. doi: 10.1177/2050640615627533. Epub 2016 Jan 19.
Risk factors for complications in patients with ulcerative colitis.
United European gastroenterology journal
Christine N Manser, Jan Borovicka, Frank Seibold, Stephan R Vavricka, Peter L Lakatos, Michael Fried, Gerhard Rogler,
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland; Division of Gastroenterology, See-Spital Horgen, Horgen, Switzerland.
- Department of Gastroenterology and Hepatology, Kantonsspital St Gallen, Switzerland.
- Crohn-Colitis Centre Bern-Fribourg, Switzerland.
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland; Department of Gastroenterology and Hepatology, Triemlispital, Zurich, Switzerland.
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary.
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
PMCID: PMC4804379 DOI: 10.1177/2050640615627533
BACKGROUND: Patients with ulcerative colitis may develop extraintestinal manifestations like erythema nodosum or primary sclerosing cholangitis or extraintestinal complications like anaemia, malabsorption or they may have to undergo surgery.
OBJECTIVE: The aim of this study was to investigate potential risk factors for complications like anaemia, malabsorption or surgery in ulcerative colitis.
METHODS: Data on 179 patients with ulcerative colitis were retrieved from our cross-sectional and prospective Swiss Inflammatory Bowel Disease Cohort Study data base for a median observational time of 4.2 years. Data were compared between patients with (n = 140) or without (n = 39) complications. Gender, age at diagnosis, smoking status, disease extent, delay of diagnosis or therapy, mesalamine (5-ASA) systemic and topical therapy, as well as other medication were analysed as potential impact factors.
RESULTS: In the multivariate regression analysis a delay of 5-ASA treatment by at least two months (odds ratio (OR) 6.21 (95% confidence interval (CI) 2.13-18.14), p = 0.001) as well as a delay with other medication with thiopurines (OR 6.48 (95% CI 2.01-20.91), p = 0.002) were associated with a higher risk for complications. This significant impact of a delay of 5-ASA therapy was demonstrated for extraintestinal manifestations (EIMs) as well as extraintestinal complications (EICs). Extensive disease as well as therapy with methotrexate showed a significantly increased risk for surgery (extensive disease: OR 2.62 (1.02-6.73), p = 0.05, methotrexate: OR 5.36 (1.64-17.58), p = 0.006).
CONCLUSIONS: A delay of 5-ASA therapy of more than two months in the early stage of ulcerative colitis (UC) constitutes a risk for complications during disease course. Extensive disease is associated with a higher risk for surgery.
Keywords: Ulcerative colitis; complication; extraintestinal manifestation; mesalamine; risk factor
- Am J Gastroenterol. 2005 Nov;100(11):2478-85 - PubMed
- Am J Gastroenterol. 2007 Apr;102(4):829-36 - PubMed
- Nat Rev Gastroenterol Hepatol. 2013 Oct;10(10):585-95 - PubMed
- PLoS One. 2014 Apr 07;9(4):e94208 - PubMed
- Gut. 1990 Mar;31(3):329-33 - PubMed
- Inflamm Bowel Dis. 2011 Dec;17(12):2558-65 - PubMed