Ulcerative Colitis in Greece: Clinicoepidemiological Data, Course, and Prognostic Factors in 413 Consecutive Patients

Abstract

The clinical course and prognosis of ulcerative colitis was studied in a group of 413 Greek patients. The study lasted for 16 years and follow-up was achieved in 95% of the patients. Both sexes were almost equally affected, mainly between the ages of 40-49. Most of the patients lived in cities and had high educational levels. Familial clustering for inflammatory bowel disease was found in 2.7% of the patients. In most of them the disease was confined to the rectosigmoid area or left bowel and was of mild to moderate severity. The disease course included exacerbations--mainly of mild to moderate severity--and remissions. Mortality was absent during first attack, and it was generally low at the completion of the study. Excluding deaths caused by colorectal cancer, most of the deaths were unrelated to the ulcerative colitis itself. Unusual combinations of ulcerative colitis with other diseases, including diseases of autoimmune origin, were noted. There were no differences between men and women in the various clinicoepidemiologic parameters or in the course of the disease. Surgery was performed in 16.7% of patients, whereas surgery at first attack was required in 0.5%. In comparison with the nonoperated group, patients who were operated on were significantly younger at the time of onset of symptoms and had significantly more extensive disease. Factors prognostic of severe attacks and colectomy were extensive disease, young age at onset, and severe recurrences. Evolution to cancer was observed in 1.45%, whereas extraintestinal cancers also appeared in 1.5%. At the completion of the follow-up period, 5.8% of the patients were dead, 16% had only one attack, 2.7% experienced continuous symptoms, whereas in 58.8% of them, the disease course included exacerbations and remissions. On the basis of the outcome of severe attacks and the more favorable short-term prognosis, it could be argued that ulcerative colitis in Greece runs a milder course compared with that of other developed countries in Western Europe and North America.

Ulcerative colitis in northern Portugal and Galicia in Spain

“…In addition, among the elderly a notably lower severity index was found, suggesting a decline in severity in this population as interpreted from the decrease in number of exacerbations, regression in extension of the inflammatory lesions, colectomy requirements, and risk of colorectal cancer as previously reported. [38][39][40] This evidence could be helpful for future classification of UC, indicating that a more meaningful age division may be set at 60 years, stratifying patients above this age as elderly colitis. This observation was previously found in the IBSEN study, 28 suggesting that the course of UC becomes milder with increasing age, and that the initial age should be detached from the clinical classification of patients.…”

Histopathology Predictors of Medically Refractory Ulcerative Colitis

“…23,24 It is unclear to what extent specific well-known histologic findings in UC are predictive of medically refractory disease. [11][12][13][14][15] We sought to determine whether histologic variables have utility to predict future medically refractory disease.…”

“…1 Proposed predictors of future colectomy for severe UC have included the presence of cryptitis, crypt abscesses and ulcerations, lymphocyte steroid responsiveness, C-reactive protein, the extent of disease found by endoscopy, hematochezia, and bowel frequency. [11][12][13][14][15] Histologic abnormalities in UC include 1) crypt architectural changes (distortion, branching, and loss); 2) inflammatory mononuclear cell infiltrate of the lamina propria; 3) neutrophil inflammation (cryptitis); and 4) epithelial cell injury including erosions and ulcers. 16 -19 This study was undertaken to determine whether well-described histologic findings seen in UC predict progression to medically refractory disease.…”

Enfermedades inflamatorias intestinales: Experiencia de dos centros chilenos

“…Las EII son más frecuentes en el sexo femenino y se presentan principalmente en el adulto joven 1,[17][18][19][33][34][35][36][37][38] . El hecho que la mayoría de los casos fueran diagnosticados después del año 1995 podría sugerir una tendencia al aumento del diagnóstico de estas enfermedades en los últimos años, lo que también ocurre en otros países 1,8,17 .…”