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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,


  1. Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland; Division of Gastroenterology, See-Spital Horgen, Horgen, Switzerland.
  2. Department of Gastroenterology and Hepatology, Kantonsspital St Gallen, Switzerland.
  3. Crohn-Colitis Centre Bern-Fribourg, Switzerland.
  4. Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland; Department of Gastroenterology and Hepatology, Triemlispital, Zurich, Switzerland.
  5. 1st Department of Medicine, Semmelweis University, Budapest, Hungary.
  6. Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.

PMID: 27087958 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


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