Long-term prognosis of ulcerative colitis and its temporal change between 1977 and 2013: a hospital-based cohort study from Korea.

BACKGROUND AND AIMS

No previous large-scale studies have evaluated the prognosis of ulcerative colitis (UC) over a period of three decades in a non-Caucasian population. The aims of this study were to update the current information on the natural course of UC in a sizable cohort of Korean patients and to evaluate changes in the treatment paradigms and prognosis of UC over time.

METHODS

We retrospectively analyzed 2802 Korean UC patients who visited Asan Medical Center. We divided the study subjects into three groups based on the year of diagnosis (cohort 1: 1977–1999; cohort 2: 2000–2006; and cohort 3: 2007–2013).

RESULTS

Five-year cumulative probabilities of prescription of thiopurines (azathioprine or 6-mercaptopurine) and anti-tumor necrosis factor (anti-TNF) agents were 4.1% and 0.0%, respectively, in cohort 1 and 27.9% and 12.7%, respectively, in cohort 3 (P < 0.001). A total of 209 patients (7.5%) underwent colectomy, producing cumulative probabilities of colectomy at 10, 20 and 30 years after diagnosis of 7.8%, 14.2% and 21.3%, respectively. The cumulative probability of colectomy was especially low in patients first diagnosed at our center: 3.1% at 10 years and 4.5% at 20 years. Moreover, the cumulative probability of colectomy decreased significantly over the last 30 years (P = 0.039).

CONCLUSION

Thiopurines and anti-TNF agents are used increasingly more frequently and earlier, while the colectomy rate has decreased over the last 30 years in Korean patients with UC. Korean UC patients may have a better clinical course than Western cases, as indicated by a lower colectomy rate.