Ulcerative Colitis: Are We Neglecting Its Progressive Character

Abstract

"lead pipe," 16% with pseudopolyps, and 3% with stenosis and fibrous bridges. Reference to functional anorectal disorders was identified in 49%, mostly previous and self-limited episodes of incontinence, but including persistent incontinence in 10% (CCIS 8 ± 4.8). There was an increased incidence of structural damage and anorectal dysfunction in patients who needed corticosteroid therapy (p = 0.001), immunosuppressants (p < 0.001), and anti-TNFs (p = 0.002) and an association of structural damage with anorectal dysfunction (p < 0.001). There was no association between age and anorectal dysfunction, including incontinence episodes. Conclusions: UC is a disease with structural and functional consequences in a significant subset of patients. This should be incorporated when defining the therapeutic strategy. AbstractIntroduction: Ulcerative colitis (UC) is a chronic disease but its progressive character, with structural damage, is insufficiently studied. Objectives: To analyze a group of patients without referral bias, regarding its clinical course, the morphological damage, and functional status. Methods: We evaluated UC patients diagnosed between January 1, 2000 and December 31, 2004, living in the direct referral area of the hospital and determined the medication use, colectomy rate, structural damage ("lead pipe," stenosis, pseudopolyps, fibrous bridges), and anorectal function (prospective evaluation with the Cleveland Clinic Incontinence Score [CCIS] and the Fecal Incontinence Quality of Life Scale). Results: We identified 104 patients, 47% female, with a mean age at diagnosis of 38 ± 17 years, 24% with proctitis, 57% with left colitis, and 19% with pancolitis. In 3 patients, it was not possible to obtain follow-up data. Of the studied patients, 56% needed corticosteroid therapy, 38% immunosuppressants, and 16% anti-tumor necrosis factors (anti-TNFs). After a mean follow-up of 13 ± 2 years, we found structural damage in 25 patients (24%): 5% with proctocolectomy, 15% with ResumoIntrodução: A colite ulcerosa (CU) é uma doença crónica mas o seu carácter progressivo, com danos estruturais, encontra-se insuficientemente estudado. Objetivos: Analisar um grupo de doentes, sem viés de referenciação, quanto ao percurso clínico, aos danos morfológicos e ao estado funcional. Métodos: Avaliaram-se os doentes com diagnóstico de CU estabelecido entre 01-01-2000 e 31-12-2004, com residência na área de referenciação directa do hospital, tendo-se determinado a medicação usada, a taxa de colectomia, os danos estruturais ("cano de chumbo", estenoses, pseudopolipos, pontes fibrosas) ou funcionais ano-rectais (avaliação prospectiva com Cleaveland Clinic Incontinence Score, CCIS e Fecal Incontinence Quality of Life, FIQL). Resultados: Identificaram-se 104 doentes, 47% do sexo feminino, idade média no diagnós-tico de 38 ± 17 anos, proctite 24%, colite esquerda 57%, pancolite 19%. Em 3 doentes não foi possível obter dados de seguimento. Dos doentes estudados 56% tiveram necessidade de corticoterapia, 38% de imunossupressores e ...

Long‐term follow‐up of patients treated with aminosalicylates for ulcerative colitis: Predictive factors of response: An observational case‐control study

“…Therefore, we performed subgroup analysis considering different step‐up approaches individually confirming the same predictive risk for IMM and biological therapies. Evaluating risks for colonic extension, endoscopic progressive features and EIMs, our findings are in agreement with previous studies, providing new evidence about extent progression associated to biological therapy and EIM appearance related with IMM use 20–24 . An important point is the association of age and immunosuppressive therapy use, differing from the Swiss IBD cohort registry and the ACCESS Group observations 20 , 25 .…”

“…Evaluating risks for colonic extension, endoscopic progressive features and EIMs, our findings are in agreement with previous studies, providing new evidence about extent progression associated to biological therapy and EIM appearance related with IMM use. [20][21][22][23][24] An important point is the association of age and immunosuppressive therapy use, differing from the Swiss IBD cohort registry and the ACCESS Group observations. 20,25 In terms of surgery, extensive colitis, previous exposure to IMM, steroid refractoriness and disease diagnosis in the prebiologic era were shown to impact the likelihood of the patient requiring a colectomy; these results are in keeping with previously published articles.…”

Clinical outcomes with ustekinumab as rescue treatment in therapy‐refractory or therapy‐intolerant ulcerative colitis

“…1,2 Although the advent of biologics like the anti-tumour necrosis factor (TNF)-antibodies infliximab, adalimumab and golimumab, and more recently the anti-integrin-antibody vedolizumab, have substantially improved the therapeutic options in UC, 3 mucosal healing rates are low and still 10–16% of patients lose their colon due to therapy-refractory situations. 1,4 In addition, reluctance to use potent drugs earlier in the course of their disease 5 and the structural damage due to ongoing inflammation 6,7 could contribute to this dilemma.…”

A Step Forward in the Understanding of Structural and Functional Bowel Damage in Patients with Ulcerative Colitis

“…In the population presented by Massinha et al [9], proximal disease extension was found in 12% of the patients, strictures in 3%, pseudopolyposis in 16%, and bridging fibrosis in 3%, and 15% of the patients presented a "lead pipe" colon on colonoscopy. Interestingly, anorectal dysfunction was reported in 49% of the patients, as evaluated by the CCIS score, 10% of which had persistent symptoms of incontinence.…”

“…In this issue of GE -Portuguese Journal of Gastroenterology, Massinha et al [9] presented a retrospective study including 104 patients with UC, currently living in a tertiary referral hospital area, in whom they evaluated the presence of structural and functional bowel damage.…”