Solberg IG, Lygren I, Jahnsen J, et al.. Clinical course during the first 10 years of ulcerative colitis: results from a population-based inception cohort (IBSEN Study)

Department of Gastroenterology, Ullevål University Hospital, Oslo, Norway.
Scandinavian Journal of Gastroenterology (Impact Factor: 2.36). 07/2009; 44(4):431-440. DOI: 10.1080/00365520802600961


Cohort studies of unselected and newly diagnosed patients are essential for a better understanding of the prognosis in ulcerative colitis (UC). The aim of this study was to evaluate the course of UC in a population-based inception cohort during the first 10 years, and to identify prognostic risk factors based on information gathered at diagnosis.

Material and methods:
From 1990 to 1994, a population-based cohort of 843 patients with inflammatory bowel disease was enrolled in South-Eastern Norway. The cohort was systematically followed-up at 1, 5 and 10 years after diagnosis.

Of 519 patients with UC, 423 completed the 10-year follow-up, 53 died and 43 were lost to follow-up. The mortality risk was not increased compared with that in the general population. The cumulative colectomy rate after 10 years was 9.8% (95% CI: 7.4-12.4%). Initial presentation with extensive colitis and erythrocyte sedimentation rate (ESR) > or =30 mm/h was associated with an increased hazard ratio (HR) (3.57, 95% CI: 1.60-7.96) and age > or =50 years at diagnosis, with reduced HR (0.28, 95% CI: 0.12-0.65) for subsequent colectomy. Relapsing disease was noted in 83%, but half (48%) of the patients were relapse free during the last 5 years. One-fifth (69/288) of patients with proctitis or left-sided colitis had progressed to extensive colitis.

The prognosis for UC during the first 10 years was generally good. The colectomy rate was low, and a large proportion of patients were in remission as time progressed. Patients with initially extensive colitis and elevated ESR could benefit from an early potent medical treatment strategy.

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Available from: Bjørn Moum, Oct 10, 2014
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    • "This procedure allows for the detection of elemental endoscopic lesions and for tissue sampling to confirm diagnosis [4]. Endoscopic findings have a major influence on disease outcomes in both CD [5] [6] [7] [8] and UC [9] [10] [11] [12] when the most severe endoscopic lesions are present. More recently, treatment-induced healing of mucosal lesions has been associated with more favourable long-term IBD courses [13] [14] [15] [16] [17] [18]. "
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    ABSTRACT: Background Endoscopic activity has become a therapeutic endpoint in inflammatory bowel disease. Aim of this study was to evaluate inter-observer agreement for endoscopic scores in a real-life setting. Methods 14 gastroenterologists with experience in inflammatory bowel disease care and endoscopic scoring reviewed videos of ulcerative colitis (n = 13) and postoperative (n = 10) and luminal (n = 8) Crohn's disease. The Mayo subscore for ulcerative colitis, Rutgeerts score for postoperative Crohn's disease, Crohn's disease endoscopic index of severity (CDEIS), and the simple endoscopic score-Crohn's disease (SES-CD) for luminal Crohn's disease were calculated. A subset of five endoscopic clips were assessed by 30 general gastroenterologists without specific experience in endoscopic scores. Kappa statistics and intraclass correlation coefficients were used to measure agreement. Results Mayo subscore agreement was suboptimal: kappas were 0.53 (95% confidence interval 0.47–0.56) and 0.71 (0.67–0.76) for the two groups. Rutgeerts score agreement was fair: kappas were 0.57 (0.51–0.65) and 0.67 (0.60–0.72). Agreements for CDEIS and SES-CD were good: intraclass correlation coefficients for the two groups were 0.83 (0.54–1.00) and 0.67 (0.36–0.97) for CDEIS and 0.93 (0.76–1.00) and 0.68 (0.35–0.97) for SES-CD, respectively. Conclusion The reproducibility of endoscopic scores in inflammatory bowel disease remains suboptimal, which could potentially have major effects on therapeutic choices.
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    • "In UC patients calcineurin inhibitors, like cyclosporine and tacrolimus, are alternative drugs for induction of remission in severe refractory cases, non-responsive to first line medication [7] [9] [10]. Still, current IBD treatment protocols have potential adverse side effects [8] [11] and only 17% of UC [12] and 10% of CD patients [13] remain in remission ten years after diagnosis. Thus, there is a clear need for novel efficacious therapies in IBD. "
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    ABSTRACT: Piroxicam administration is a method for induction of enterocolitis in interleukin-10 knockout (IL-10 k.o.) mice. The piroxicam-accelerated colitis (PAC) IL-10 k.o. model combines a dysregulated immune response against the gut microbiota with a decreased mucosal integrity. The predictive validity and pathogenic mechanisms of the model have not been thoroughly investigated. In this study, IL-10 k.o. mice received piroxicam in the chow, and model qualification was performed by examining the efficacy of prophylactic anti-IL-12/23p40 monoclonal antibody (mAb), anti-TNFα mAb, cyclosporine A (CsA) and oral prednisolone treatment. To evaluate cell involvement in the disease pathogenesis, specific cell subsets were depleted by treatment with anti-CD4 mAb, anti-CD8 mAb or clodronate-encapsulated liposomes. T cell receptor co-stimulation was blocked by CTLA4-Ig. Cytokine profiling ELISAs and calprotectin immunohistochemistry were performed on colon tissue. Treatments with anti-IL-12/23p40 mAb and CsA prevented disease in PAC IL-10 k.o. mice and reduced IFNγ, IL-17A, MPO and calprotectin levels in colon. Anti-TNFα mAb treatment caused amelioration of selected clinical parameters. No effect of prednisolone was detected. Depletion of CD8(+) cells tended to increase mortality, whereas treatment with anti-CD4 mAb or CTLA4-Ig had no significant effect on disease development. Clodronate liposome treatment induced a loss of body weight; nevertheless macrophage depletion was associated with a significant reduction in colonic pathology. In conclusion, reference drugs with known efficacy in severe inflammatory bowel disease were efficacious in the PAC IL-10 k.o. model. Our data indicate that in this model macrophages are a main driver of colitis, whereas CD4(+) cells are not.
    Full-text · Article · May 2014 · International immunopharmacology
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    • "In the aforementioned EC IBD study in which a large number of patients were followed up for 10 years after diagnosis, no increase in SMR among UC patients was noted [59]. Similarly, in the IBSEN cohort, no significant overall increase in mortality risk was found either 10 years [2] or 20 years [38] after diagnosis. Finally, in a meta-analysis of 22 studies published between 1982 and 2010 [60], the authors could not detect any increased risk of death in UC patients compared to community controls. "
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    ABSTRACT: The clinical course of ulcerative colitis (UC) may range from a quiescent course with prolonged periods of remission to fulminant disease requiring intensive medical treatment or surgery. Disease outcome is often determined by relapse rates, the development of colorectal cancer (CRC) and mortality rates. Early patient classification, identifying those with a high risk of developing complicated disease, is essential for choosing appropriate treatment. This paper reviews the clinical outcomes of UC patients as reported in population-based and observational studies representative of the whole patient population. Extensive colitis, a high level of systemic symptoms and young age at diagnosis are factors associated with a high risk of colectomy. Patients with distal disease who progress to extensive colitis seem to be a subgroup with an especially high risk of colectomy. Some prognostic factors of severe disease have been identified which could be used to optimize treatment and possibly reduce future complications. The overall risk of CRC and mortality was not significantly different from that of the background population. These results may have implications for follow-up strategies, especially regarding endoscopic surveillance of UC patients.
    Full-text · Article · Mar 2014 · Annals of Gastroenterology
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