Predictors of disease severity in ulcerative colitis patients from Southwestern Ontario.

Division of Gastroenterology, London Health Sciences Centre, Victoria Hospital, 800 Commissioner's Road East, London, Ontario, N6A 5W9, Canada.
World Journal of Gastroenterology (Impact Factor: 2.43). 01/2010; 16(2):232-6.
Source: PubMed

ABSTRACT To understand the demographic characteristics of patients in Southwestern Ontario, Canada with ulcerative colitis (UC) in order to predict disease severity.
Records from 1996 to 2001 were examined to create a database of UC patients seen in the London Health Sciences Centre South Street Hospital Inflammatory Bowel Disease Clinic. To be included, patients' charts were required to have information of their disease presentation and a minimum of 5 years of follow-up. Charts were reviewed using standardized data collection forms. Disease severity was generated during the chart review process, and non-endoscopic Mayo Score criteria were collected into a composite.
One hundred and two consecutive patients' data were entered into the database. Demographic analyses revealed that 51% of the patients were male, the mean age at diagnosis was 39 years, 13.7% had a first degree relative with inflammatory bowel disease (IBD), 61.8% were nonsmokers and 24.5% were ex-smokers. In 22.5% of patients the disease was limited to the rectum, in 21.6% disease was limited to the sigmoid colon, in 22.5% disease was limited to the left colon, and 32.4% of patients had pancolitis. Standard multiple regression analysis which regressed a composite of physician global assessment of disease severity, average number of bowel movements, and average amount of blood in bowel movements on year of diagnosis and age at time of diagnosis was significant, R(2) = 0.306, F (7, 74) = 4.66, P < 0.01. Delay from symptoms to diagnosis of UC, gender, family history of IBD, smoking status and disease severity at the time of diagnosis did not significantly predict the composite measure.
UC severity is associated with younger age at diagnosis and year of diagnosis in a longitudinal cohort of UC patients, and may identify prognostic UC indicators.

  • [Show abstract] [Hide abstract]
    ABSTRACT: With the introduction of anti-TNF therapies in the treatment of IBD, the therapeutic strategies have changed to an accelerated step-up care to avoid long-term complications. Little is known about the implementation of these strategies into daily care. We aimed to evaluate this question and to identify factors associated with the early use of immunosuppressants or anti-TNF therapies in a population-based IBD cohort. Patients with an IBD diagnosed between January 2004 and December 2008 were included. Medical therapies were evaluated at first diagnosis and during a 5-year follow-up. Risk factors associated with the initiation of an immunosuppressive therapy were assessed. Two hundred and forty-one patients were evaluated (145 Crohn's disease (CD), 96 ulcerative colitis (UC)). An immunosuppressive or anti-TNF therapy was started in 83 CD (57.2 %) and 40 UC (43 %) patients (p = 0.033, relative risks (RR) 1.77; 95 % confidence interval (CI) 1.05-3.0). After 5 years, 38.8 % CD patients on immunosuppressive therapy were treated with anti-TNF therapies. The use of corticosteroids at first diagnosis, disease localization and surgery were independent predictors for an immunosuppressive or anti-TNF therapy in CD. In UC, the extension of disease was associated with immunosuppressive therapies. The use of steroids and localization in CD patients and an extended disease in UC patients affected the time until an immunosuppressive therapy was started. We found a high proportion of patients using an immunosuppressive therapy during the early course. Therefore, the accelerated step-up strategy seems to be successfully implemented in the daily care of IBD patients. We were able to identify several factors associated with an immunosuppressive or anti-TNF therapy in CD and UC.
    International Journal of Colorectal Disease 09/2014; DOI:10.1007/s00384-014-2002-z · 2.42 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: It is a challenge to accurately identify patients with early-stage ulcerative colitis (UC) who are at highest risk for a poor outcome and might therefore require salvage therapy. Several epidemiologic and clinical studies have analyzed factors associated with poor prognosis and increased risk for colectomy. We review prognostic factors for adults with newly diagnosed UC and discuss which patients might benefit from rapid and progressive therapy. Patients with poor prognoses tend to be young nonsmokers with high levels of inflammatory biomarkers, low levels of hemoglobin, and extensive disease, based on colonoscopy. We examine these risk factors in 2 hypothetical patients who have been newly diagnosed with UC.
    Clinical Gastroenterology and Hepatology 06/2014; 13(4). DOI:10.1016/j.cgh.2014.03.037 · 6.53 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Data regarding the long-term outcomes of restorative proctocolectomy and ileal pouch anal anastomosis including pouch function and quality of life in the pediatric population are limited in pediatric patients. Study Design Indications for surgery, complications, long-term function and quality of life were evaluated in patients undergoing ileal pouch anal anastomosis at pediatric age. Assessment of quality of life was performed using the Cleveland Global Quality of Life score. Results There were 433 patients with a mean age of 18.04±2.9 years. Final pathological diagnosis was ulcerative colitis/indeterminate colitis (78.3%), familial adenomatous polyposis (15.7%), Crohn’s disease (5.1%) and others (0.9%). 237 patients (54.7%) underwent total proctocolectomy and ileal pouch anal anastomosis while 196 (45.3%) underwent initial subtotal colectomy followed by completion proctectomy with ileal pouch anal anastomosis. Anastomosis was stapled in 352 patients (81.3%) and hand-sewn in 81 (18.7%) patients. Mean follow-up was 108.5±78.4 months. At the most recent follow-up, mean Cleveland Global Quality of Life score was 0.8±0.2 and daytime and nighttime frequency of bowel movements were 5.3±3.1 and 1.6±1.3 respectively. The majority of the patients (86.8%) were fully continent or only complained of rare incontinence. Most patients had no seepage (day: 84.3%, night: 72.4%) and did not wear any pads (day: 89.3%, night: 84.3%). Most denied dietary (71.3%), social (84.8%), work (85.7%) or sexual restrictions (87.6%) at the time of last follow-up. 92.7% of patients said they would undergo ileal pouch anal anastomosis again and 95.2% would recommend surgery to others. Conclusions Restorative proctocolectomy with ileal pouch-anal anastomosis can be performed in pediatric patients with acceptable morbidity and is associated with good long-term results in terms of gastrointestinal function, quality of life, and patient satisfaction.
    Journal of the American College of Surgeons 01/2013; DOI:10.1016/j.jamcollsurg.2013.11.019 · 4.45 Impact Factor


Available from