Shao Yu-Pei, Han Tao-Tao, Lv Hong, Yang Sun-Ting, Zhu Qing-Li, Li Ji, Li Jing-Nan
Department of Gastroenterology, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China.
Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China.
World J Gastroenterol. 2025 Sep 7;31(33):109938. doi: 10.3748/wjg.v31.i33.109938.
Strictures in ulcerative colitis (UC) are relatively uncommon but are associated with increased risk of malignancy and complications. Until recently, fibrogenesis and strictures have remained largely unexplored in UC.
To investigate the incidence, long-term prognosis and risk factors of colorectal strictures in a large cohort of UC patients.
A total of 938 hospitalized UC patients at Peking Union Medical College Hospital were included from 2014 to 2024. Stricture was defined as a fixed localized narrowing of the colorectal lumen. Risk factors for stricture formation were identified by multivariable Cox regression. Prognosis was analyzed using the Kaplan-Meier or Fine-Gray method. Sensitivity analysis excluded malignant strictures due to their distinct pathophysiology.
The overall incidence of stricture was 12.4% over a median follow-up of 8.70 years, with a 10-year cumulative probability of 11.3%. Malignancy occurred in 8.6% of stricture cases. UC patients with strictures were at higher risk for intestinal complications, surgery and malignancy ( < 0.05). The 10-year cumulative probabilities of surgery and all-cause mortality were 37.6% and 1.6%, respectively. Age ≥ 40 years at diagnosis [hazard ratio (HR) = 2.197, 95% confidence interval (CI): 1.487-3.242] and extraintestinal manifestations (HR = 2.072, 95%CI: 1.326-3.239) were associated with higher stricture risk, while the use of biological agents such as vedolizumab (HR = 0.382, 95%CI: 0.203-0.720) was protective against strictures ( < 0.05). Sensitivity analysis on benign strictures showed consistent findings, with similar risk factors and worse long-term outcomes.
UC patients with strictures had worse long-term prognostic outcomes. Earlier endoscopic surveillance and biologic treatment should be considered in patients ≥ 40 years or those with extraintestinal manifestations.
溃疡性结肠炎（UC）中的狭窄相对少见，但与恶性肿瘤及并发症风险增加相关。直到最近，UC中的纤维生成和狭窄在很大程度上仍未得到充分研究。
调查一大群UC患者中结直肠狭窄的发生率、长期预后及危险因素。
纳入2014年至2024年在北京协和医院住院的938例UC患者。狭窄定义为结直肠管腔的固定局限性狭窄。通过多变量Cox回归确定狭窄形成的危险因素。使用Kaplan-Meier法或Fine-Gray法分析预后。敏感性分析排除了因病理生理不同而导致的恶性狭窄。
在中位随访8.70年期间，狭窄的总体发生率为12.4%，10年累积概率为11.3%。8.6%的狭窄病例发生了恶性肿瘤。有狭窄的UC患者发生肠道并发症、手术及恶性肿瘤的风险更高（P<0.05）。手术和全因死亡率的10年累积概率分别为37.6%和1.6%。诊断时年龄≥40岁[风险比（HR）=2.197，95%置信区间（CI）：1.487-3.242]和肠外表现（HR = 2.072，95%CI：1.326-3.239）与更高的狭窄风险相关，而使用维多珠单抗等生物制剂（HR = 0.382，95%CI：0.203-0.720）对狭窄有保护作用（P<0.05）。对良性狭窄的敏感性分析显示了一致的结果，危险因素相似且长期结局更差。
有狭窄的UC患者长期预后较差。对于年龄≥40岁或有肠外表现的患者，应考虑更早进行内镜监测和生物治疗。
