Severity of inflammation as a predictor of colectomy in patients with chronic ulcerative colitis

Marco M. Hefti, David B. Chessin, Noam Harpaz, Randolph M. Steinhagen, Thomas A. Ullman

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

PURPOSE: We evaluated a large cohort of patients with longstanding ulcerative colitis in a colonoscopic surveillance program to determine predictors of colectomy. METHODS: We queried a retrospective database of patients who had symptoms of ulcerative colitis for seven years or more. Histologic inflammation in biopsies was graded on a validated four-point scale: absent, mild, moderate, severe. We performed a multivariate analysis of the inflammation scores and other variables to determine predictive factors for colectomy. Patients who underwent colectomy for neoplasia were censored at the time of surgery*those who did not undergo colectomy were censored at the time of last contact. RESULTS: A total of 561 patients were evaluated, with a median follow-up of 21.4 years since disease onset. A total of 97 patients (17.3 percent) underwent surgery*25 (4.5 percent) for reasons other than dysplasia. These 25 constitute events for this analysis. For univariate analysis, mean inflammation (P G 0.001) and steroid use (P = 0.01) were predictors of colectomy. For multivariable proportional hazards analysis, mean inflammation (P G 0.001) and steroid use (P = 0.03) were predictors of colectomy, whereas salicylate use (P = 0.007) was protective. CONCLUSIONS: Higher median inflammation scores and corticosteroid use were predictors of colectomy in this patient population. The overall rate of colectomy during a long period of follow-up was low (G1 percent per year).

Original languageEnglish (US)
Pages (from-to)193-197
Number of pages5
JournalDiseases of the Colon and Rectum
Volume52
Issue number2
DOIs
StatePublished - Feb 1 2009
Externally publishedYes

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Colectomy
Ulcerative Colitis
Inflammation
Steroids
Salicylates
Adrenal Cortex Hormones
Multivariate Analysis
Databases
Biopsy

Keywords

  • Colectomy
  • Dysplasia
  • Inflammation
  • Ulcerative colitis

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Severity of inflammation as a predictor of colectomy in patients with chronic ulcerative colitis. / Hefti, Marco M.; Chessin, David B.; Harpaz, Noam; Steinhagen, Randolph M.; Ullman, Thomas A.

In: Diseases of the Colon and Rectum, Vol. 52, No. 2, 01.02.2009, p. 193-197.

Research output: Contribution to journalArticle

Hefti, Marco M. ; Chessin, David B. ; Harpaz, Noam ; Steinhagen, Randolph M. ; Ullman, Thomas A. / Severity of inflammation as a predictor of colectomy in patients with chronic ulcerative colitis. In: Diseases of the Colon and Rectum. 2009 ; Vol. 52, No. 2. pp. 193-197.
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N2 - PURPOSE: We evaluated a large cohort of patients with longstanding ulcerative colitis in a colonoscopic surveillance program to determine predictors of colectomy. METHODS: We queried a retrospective database of patients who had symptoms of ulcerative colitis for seven years or more. Histologic inflammation in biopsies was graded on a validated four-point scale: absent, mild, moderate, severe. We performed a multivariate analysis of the inflammation scores and other variables to determine predictive factors for colectomy. Patients who underwent colectomy for neoplasia were censored at the time of surgery*those who did not undergo colectomy were censored at the time of last contact. RESULTS: A total of 561 patients were evaluated, with a median follow-up of 21.4 years since disease onset. A total of 97 patients (17.3 percent) underwent surgery*25 (4.5 percent) for reasons other than dysplasia. These 25 constitute events for this analysis. For univariate analysis, mean inflammation (P G 0.001) and steroid use (P = 0.01) were predictors of colectomy. For multivariable proportional hazards analysis, mean inflammation (P G 0.001) and steroid use (P = 0.03) were predictors of colectomy, whereas salicylate use (P = 0.007) was protective. CONCLUSIONS: Higher median inflammation scores and corticosteroid use were predictors of colectomy in this patient population. The overall rate of colectomy during a long period of follow-up was low (G1 percent per year).

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