Natural Disease Course of Ulcerative Colitis During the First Five Years of Follow-up in a European Population-based Inception Cohort-An Epi-IBD Study

Background and Aims: Few population-based cohort studies have assessed the disease course of ulcerative colitis [UC] in the era of biological therapy and widespread use of immunomodulators. The aim of this study was to assess the 5-year outcome and disease course of patients with UC in the Epi-IBD cohort.

Methods: In a prospective, population-based inception cohort of unselected patients with UC, patients were followed up from the time of their diagnosis, which included the collection of their clinical data, demographics, disease activity, medical therapy, and rates of surgery, cancers, and deaths. Associations between outcomes and multiple covariates were analysed by Cox regression analysis.

Results: A total of 717 patients were included in the study. During follow-up, 43 [6%] patients underwent a colectomy and 163 [23%] patients were hospitalised. Of patients with limited colitis [distal to the left flexure], 90 [21%] progressed to extensive colitis. In addition, 92 [27%] patients with extensive colitis experienced a regression in disease extent, which was associated with a reduced risk of hospitalisation (hazard ratio [HR]: 0.5 95% CI: 0.3-0.8]. Overall, patients were treated similarly in both geographical regions; 80 [11%] patients needed biological therapy and 210 [29%] patients received immunomodulators. Treatment with immunomodulators was found to reduce the risk of hospitalisation [HR: 0.5 95% CI: 0.3-0.8].

Conclusions: Although patients in this population-based cohort were treated more aggressively with immunomodulators and biological therapy than in cohorts from the previous two decades, their disease outcomes, including colectomy rates, were no different. However, treatment with immunomodulators was found to reduce the risk of hospitalisation.

Media Type:

Electronic Article

Year of Publication:


Contained In:

Journal of Crohn's & colitis - Vol. 13, No. 2 (2019), p. 198-208




Burisch, Johan
Katsanos, Konstantinos H
Christodoulou, Dimitrios K
Barros, Luisa
Magro, Fernando
Pedersen, Natalia
Kjeldsen, Jens
Vegh, Zsuzsanna
Lakatos, Peter L
Eriksson, Carl
Halfvarson, Jonas
Fumery, Mathurin
Gower-Rousseau, Corinne
Brinar, Marko
Cukovic-Cavka, Silvija
Nikulina, Inna
Belousova, Elena
Myers, Sally
Sebastian, Shaji
Kiudelis, Gediminas
Kupcinskas, Limas
Schwartz, Doron
Odes, Selwyn
Kaimakliotis, Ioannis P
Valpiani, Daniela
D'Incà, Renata
Salupere, Riina
Chetcuti Zammit, Stefania
Ellul, Pierre
Duricova, Dana
Bortlik, Martin
Goldis, Adrian
Kievit, Hendrika Adriana Linda
Toca, Alina
Turcan, Svetlana
Midjord, Jóngerð
Nielsen, Kári Rubek
Andersen, Karina Winther
Andersen, Vibeke
Misra, Ravi
Arebi, Naila
Oksanen, Pia
Collin, Pekka
de Castro, Luisa
Hernandez, Vicent
Langholz, Ebbe
Munkholm, Pia
Epi-IBD Group




Colitis, Ulcerative
Disease Progression
Follow-Up Studies
Gastrointestinal Agents
Immunologic Factors
Journal Article
Middle Aged
Prospective Studies


Date Completed 28.05.2019

Date Revised 28.05.2019

published: Print

Citation Status MEDLINE

Copyright: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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