Survival and causes of death in Italian patients with ulcerative colitis - A GISC* nation-wide study

University of Naples Federico II, Napoli, Campania, Italy
Digestive and Liver Disease (Impact Factor: 2.96). 11/2001; 33(8):686-92. DOI: 10.1016/S1590-8658(01)80046-3
Source: PubMed


Death rate for patients with ulcerative colitis has changed over last few decades. Recent studies indicate that cumulative long-term mortality is comparable to that in general population, and that deaths may depend on causes not strictly related to colonic disease.
To evaluate overall and cause-specific mortality rate in a large group of Italian patients with ulcerative colitis.
A total of 2,066 ulcerative colitis patients aged >18 years consecutively diagnosed in twenty Italian Gastroenterology Units between 1964 and 1995 were followed-up from diagnosis until 1997. Standardised Mortality Ratios and Relative Survival Ratios were calculated.
Overall mortality of patients with ulcerative colitis was comparable to that in general population with 93 deaths observed versus 92.1 expected (standardises mortality ratio, 1.0; 95% confidence interval, 0.8-1.2). Significantly higher mortality was observed in patients under 30 years of age at diagnosis (standardised mortality ratio, 2.7; 95% confidence interval, 1.3-4.9), and in those diagnosed before 1974 (standardised mortality ratio, 2.7; 95% confidence interval, 1.1-5.7). Proctocolitis and complications from surgery were mentioned in 11 and 5 certificates, respectively. A significant excess of deaths was observed for colorectal cancer (colon: standardised mortality ratio, 3.0; 95% confidence interval, 1.0-6.9; rectum: standardised mortality ratio, 4.4; 95% confidence interval, 1.2-11.3), and haemolymphopoietic neoplasms (standardised mortality ratio, 2.8; 95% confidence interval, 1.0-6.1), in particular multiple myeloma and non-Hodgkin lymphoma. A significant deficit of deaths was observed for cancer of the respiratory system (standardised mortality ratio, 0.3; 95% confidence interval, 0.1-1.0).
This study confirms that, also in Italy, mortality of patients with ulcerative colitis is comparable to that in general population. Only 12% of deaths were due to ulcerative colitis itself, whereas 10% of deaths were attributed to colorectal cancer. Deaths from colorectal cancer occurred, on average, 9 years after diagnosis of ulcerative colitis, suggesting that the risk of cancer is not limited to patients with long-standing colitis. As to mortality for causes unrelated to colitis, there was an excess of deaths due to malignancies of the haemolymphopoietic system.

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Available from: Claudio Papi, Dec 30, 2013
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    • "Similarly, Winther et al in 2003 reported an increased mortality in older patients26 in the first 2 years after diagnosis. However, Viscido et al reported a higher mortality in patients less than 30 years of age.27 A recent review of the literature suggests that the age at diagnosis of UC does not affect the standard mortality ratios when compared with the general population.25 "
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    ABSTRACT: Inflammatory bowel disease, especially ulcerative colitis, is increasing in many "non-Western" countries, including Sri Lanka. The aim was to evaluate long-term outcomes of ulcerative colitis in a Sri Lankan population. A retrospective cohort study was conducted at the gastroenterology clinics of the Colombo North Teaching Hospital, Ragama and the National Hospital of Sri Lanka, Colombo; the two major referral centers for ulcerative colitis. All cases had histological confirmation of ulcerative colitis. Three outcomes: colectomy, development of colorectal carcinoma, and death were assessed. Patients not attending the clinic during the previous 4 weeks, or their families, were contacted to obtain clinical details and survival status. In those who had died, the cause of death was confirmed from clinical records and death certificates. Details of 348/425 (81.9%) patients with ulcerative colitis (mean age 45.6 [standard deviation {SD} 14.3] years, male/female ratio = 1.00:1.03) were available. The mean follow-up was 6.8 (SD 6.5) years. The cumulative colectomy rates at 1, 5, 10, and 15 years were 1.5%, 4.0%, 5.5%, and 9.3% respectively. The cumulative probability of colorectal cancer in this cohort after 10 and 15 years was 0.47% and 2.36% respectively. The cumulative survival rate after 1, 5, 10, and 15 years was 99.7%, 98.9%, 98.1%, and 94.5% respectively. Patients with pancolitis were more likely to have disease-related death (P = 0.05). Multivariate analysis (Cox proportional hazards model) showed that an older age at diagnosis was associated with long-term mortality (hazard ratio, 1.11; P = 0.001). In this cohort, colectomy, colorectal carcinoma, and death rates were low, suggesting a relatively benign disease course for ulcerative colitis.
    Clinical and Experimental Gastroenterology 09/2013; 6(1):195-200. DOI:10.2147/CEG.S49202
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    • "Colitis associated CRC risk increases with both the duration and extent of the disease [3-6]. The risk of malignant transformation is particularly high for patients having the disease for longer than 8 years, for patients with UC affecting the entire colon [7]. Patients with UC are up to 30-fold more likely to develop CRC and are three times as likely as the general population to die from it [7]. "
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    ABSTRACT: N-acetyltransferase 1 (NAT1) and 2 (NAT2) are polymorphic isoenzymes responsible for the metabolism of numerous drugs and carcinogens. Acetylation catalyzed by NAT1 and NAT2 are important in metabolic activation of arylamines to electrophilic intermediates that initiate carcinogenesis. Inflammatory bowel diseases (IBD) consist of Crohn's disease (CD) and ulcerative colitis (UC), both are associated with increased colorectal cancer (CRC) risk. We hypothesized that NAT1 and/or NAT2 polymorphisms contribute to the increased cancer evident in IBD. A case control study was performed with 729 Caucasian participants, 123 CRC, 201 CD, 167 UC, 15 IBD dysplasia/cancer and 223 controls. NAT1 and NAT2 genotyping were performed using Taqman based techniques. Eight single nucleotide polymorphisms (SNPs) were characterized for NAT1 and 7 SNPs for NAT2. Haplotype frequencies were estimated using an Expectation-Maximization (EM) method. Disease groups were compared to a control group for the frequencies at each individual SNP separately. The same groups were compared for the frequencies of NAT1 and NAT2 haplotypes and deduced NAT2 phenotypes. No statistically significant differences were found for any comparison. Strong linkage disequilibrium was present among both the NAT1 SNPs and the NAT2 SNPs. This study did not demonstrate an association between NAT1 and NAT2 polymorphisms and IBD or sporadic CRC, although power calculations indicate this study had sufficient sample size to detect differences in frequency as small as 0.05 to 0.15 depending on SNP or haplotype.
    BMC Medical Genetics 02/2007; 8:28. DOI:10.1186/1471-2350-8-28 · 2.08 Impact Factor
    • "Previous Large Studies of All-Cause Mortality in IBD Patients First author, year Area Period Cohort Deaths Standardized mortality ratio (95% confidence interval) UC Langholz, 1992 19 Copenhagen 1962–1987 1104 121 107 Farrokhyar, 2001 4 3 English districts in Midlands 1978–1986 356 41 103 (79–140) Persson, 1996 12 Stockholm 1955–1984 1547 255 137 (120–154) Ekbom, 1992 10 Uppsala, Sweden 1965–1983 2509 505 140 (120–150) Palli, 1998 2 Florence 1978–1992 689 47 62 (40–80) Davoli, 1997 14 Rome 1970–1989 508 27 98 (64–142) Viscido, 2001 20 Italy 1964–1989 2066 93 100 (80–120) Gyde, 1982 3 Birmingham 1940–1976 676 141 170 CD Cottone, 1996 15 Sicily, Italy 1973–1993 531 9 97 (40–180) Farrokhyar, 2001 4 3 English districts in Midlands 1978–1986 196 23 94 (59–140) Persson, 1996 12 Stockholm 1955–1984 1251 151 (129–175) Weterman, 1990 5 Leiden, Holland 1934–1984 659 64 223 (175–285) Ekbom, 1992 10 Uppsala, Sweden 1963–1986 1469 179 160 (140–190) Palli, 1998 2 Florence 1978–1992 231 23 136 (90–200) Jess, 2002 11 Copenhagen followed 1967–1987 374 84 130 (101–150) Mayberry, 1980 21 Cardiff, UK 1930s–1970s 219 40 216 ability of death recording within GPRD and the possibility of bias within it (because of the possibility that controls may be more likely to move away without their GP knowing, and therefore more likely to die without it being recorded), we repeated the analysis excluding all subjects with no recorded medical data dated within the last year of their data. Because a diagnosis is more likely to be recorded at a time when it is causing ill health (even if it is a long-standing condition) we examined the effect of censoring data for 1 or 2 years from the date of entry to the study. "
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    ABSTRACT: There is no consensus regarding any increase in mortality with inflammatory bowel disease (IBD). In general, previous studies were not contemporary and were unable to correct for likely confounders. We have performed a large cohort study to examine contemporary IBD related mortality in the United Kingdom. We selected subjects within the General Practice Research Database with a coded diagnosis of inflammatory bowel disease and up to 5 matched controls for each. We derived the date of recorded deaths and information on smoking and a variety of medical conditions. We calculated both the absolute risk of death and the relative risk as a hazard ratio corrected for available confounders by Cox regression. We included 16,550 IBD cases with 1047 deaths and 82,917 controls with 3758 deaths. The mortality rate was 17.1 per 1000 person-years overall for IBD cases and 12.3 for controls; this difference was greatest in the elderly. Conversion of these figures to hazard ratios by Cox regression gave hazard ratios of 1.54 (1.44-1.65) for all IBD, 1.44 (1.31-1.58) for ulcerative colitis (UC), and 1.73 (1.54-1.96) for Crohn's disease. The greatest hazard ratio for UC was among the 40-59-year age group (1.79 [1.42-2.27]) and for Crohn's disease among 20-39-year-olds (3.82 [2.17-6.75]). IBD is associated with an overall small increase in mortality rate greatest in relative terms in younger subjects but in absolute terms in the elderly.
    Gastroenterology 12/2003; 125(6):1583-90. DOI:10.1053/j.gastro.2003.09.029 · 16.72 Impact Factor
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