Division of Gastroenterology, University of California San Diego, La Jolla, California; Gastroenterology Unit, Epimad Registry, Amiens University Hospital, Amiens, France.
Division of Gastroenterology, University of California San Diego, La Jolla, California; Division of Biomedical Informatics, University of California San Diego, La Jolla, California.
Clin Gastroenterol Hepatol. 2018 Mar;16(3):343-356.e3. doi: 10.1016/j.cgh.2017.06.016. Epub 2017 Jun 16.
BACKGROUND & AIMS: A comprehensive knowledge of the natural history of ulcerative colitis (UC) helps understand disease evolution, identify poor prognostic markers and impact of treatment strategies, and facilitates shared decision-making. We systematically reviewed the natural history of UC in adult population-based cohort studies with long-term follow-up.
Through a systematic literature review of MEDLINE through March 31, 2016, we identified 60 studies performed in 17 population-based inception cohorts reporting the long-term course and outcomes of adult-onset UC (n = 15,316 UC patients).
Left-sided colitis is the most frequent location, and disease extension is observed in 10%-30% of patients. Majority of patients have a mild-moderate course, which is most active at diagnosis and then in varying periods of remission or mild activity; about 10%-15% of patients experience an aggressive course, and the cumulative risk of relapse is 70%-80% at 10 years. Almost 50% of patients require UC-related hospitalization, and 5-year risk of re-hospitalization is ∼50%. The 5-year and 10-year cumulative risk of colectomy is 10%-15%; achieving mucosal healing is associated with lower risk of colectomy. About 50% of patients receive corticosteroids, although this proportion has decreased over time, with a corresponding increase in the use of immunomodulators (20%) and anti-tumor necrosis factor (5%-10%). Although UC is not associated with an increased risk of mortality, it is associated with high morbidity and work disability, comparable to Crohn's disease.
UC is a disabling condition over time. Prospective cohorts are needed to evaluate the impact of recent strategies of early use of disease-modifying therapies and treat-to-target approach with immunomodulators and biologics. Long-term studies from low-incidence areas are also needed.
全面了解溃疡性结肠炎（UC）的自然病程有助于理解疾病的演变，识别预后不良的标志物和治疗策略的影响，并促进共同决策。我们系统地回顾了具有长期随访的成人基于人群队列研究中UC 的自然病程。
通过对截至 2016 年 3 月 31 日 MEDLINE 的系统文献回顾，我们确定了 60 项在 17 项基于人群的发病队列研究中进行的研究，这些研究报告了成年发病 UC 的长期病程和结局（n=15316 例 UC 患者）。
左半结肠炎是最常见的部位，约 10%-30%的患者存在疾病扩展。大多数患者病情较轻，疾病活动度在诊断时最高，随后在不同时期缓解或轻度活动；约 10%-15%的患者病情呈侵袭性，10 年内复发的累积风险为 70%-80%。约 50%的患者需要 UC 相关住院治疗，5 年内再住院的风险约为 50%。5 年和 10 年的累积结肠切除术风险为 10%-15%；实现黏膜愈合与较低的结肠切除术风险相关。约 50%的患者接受皮质类固醇治疗，尽管随着时间的推移，这一比例有所下降，免疫调节剂（20%）和抗 TNF（5%-10%）的使用相应增加。虽然 UC 与死亡率增加无关，但它与高发病率和工作能力丧失有关，与克罗恩病相当。
UC 是一种随着时间推移而致残的疾病。需要前瞻性队列研究来评估早期使用疾病修饰疗法的新策略以及免疫调节剂和生物制剂的靶向治疗方法的影响。也需要来自低发病率地区的长期研究。
