Comparison of the Effects of Clinical Outcomes on the Number of Attacks in the Course of Ulcerative Colitis: A Single Center Study

Year 2023, Volume: 13 Issue: 4, 665 - 670, 31.07.2023

Hakan Şıvgın , Abdurrahman Şahin , Şirin Çetin

https://doi.org/10.16899/jcm.1308661

Abstract

Aim: The aim of this study was to find the factors affecting the frequency of attacks of patients diagnosed with ulcerative colitis (UC).
Method: In our single-center retrospective descriptive study, 40 UC patients who admitted to our hospital for follow-up from January 2021 to December 2022. The baseline demographic and clinical characteristics, laboratory values and, treatments during the disease course were compared among patients with number of attacks < 2 per year ( Group1) and number of attacks ≥2 per year ( Group 2).
Results: There were 25 (male∕female:11∕14) patients in Group 1 and 15 (male∕female:7∕8) patients in Group 2. No statistically significant difference was found between the mean age, sex, age of diagnosis, duration of disease, co-morbidities and extraintestinal involvement of both groups. The median CRP values were significantly higher in the Group 2, compared to the group 1 (P = 0.04). There was statistically significant differences between groups in terms of endoscopic severe activity (12% vs, 40%; p<0.001), left-sided involvement(60% vs, 40%; p=0.02), pancolonic involvement (8% vs, 33%; p<0.001), the presence of blood in stool at the time of diagnosis (80% vs 100%; p=0.03), use of biologic agents (16% vs 40%; p< 0.001) and steroids (16% vs 33%; p=0.02).
Conclusion: In UC patients who have ≥2 attacks per year presented with more advanced clinical features at onset and more severe outcomes than the number attacks < 2 per year. Blood in stool symptom and clinical parameters of severity index at the time of diagnosis are important criteria to be considered in determining the number of attacks in follow-up.

Keywords

Ulcerative Colitis, Attacks, Clinical Features, Outcomes

Klinik Parametrelerin Ülseratif Kolit Seyrinde Atak Sayılarına Etkisinin Karşılaştırılması: Tek Merkezli Çalışma

Abstract

Amaç: Bu çalışmanın amacı, ülseratif kolit (UC) tanısı alan hastaların atak sıklığını etkileyen faktörleri bulmaktır.
Yöntem: Tek merkezli retrospektif tanımlayıcı çalışmamızda, Ocak 2021-Aralık 2022 tarihleri arasında takip için hastanemize başvuran 40 UC hastası dahil edildi. Demografik ve klinik özellikler, laboratuvar değerleri ve hastalık seyri sırasındaki tedaviler, atak sayısı yılda < 2 ( Grup 1) ve atak sayısı ≥ yılda 2 ( Grup 2 ) olan hastalar arasında karşılaştırıldı.
Bulgular: Grup 1'de 25 (erkek/kadın:11/14) hasta ve Grup 2'de 15 (erkek/kadın:7/8) hasta vardı. Her iki grubun yaş ortalaması, cinsiyeti, tanı yaşı, hastalık süresi, yandaş hastalıkları ve ekstraintestinal tutulumu arasında istatistiksel olarak anlamlı fark saptanmadı. Median CRP değerleri Grup 2'de grup 1'e göre anlamlı derecede yüksekti (P=0.04). Endoskopik şiddet aktivitesi (%12'ye karşı %40; p<0.001), sol taraflı tutulum (%60'a karşı %40; p=0.02), pankolonik tutulum (%8'e karşı %33; p<0.001), tanı anında dışkıda kan varlığı (%80'e karşı %100; p=0.03), biyolojik ajan kullanımı (%16'ya karşı %40; p< 0.001) ve steroidler (%16'ya karşı %33; p=0.02) açısından gruplar arasında istatistiksel olarak anlamlı farklılıklar vardı.
Sonuç: Ülseratif kolit seyrinde yılda ≥ 2 atak olanlarda; yılda < 2 atak olanlara göre; tanı anında daha şiddetli semptomlar ve klinik parametreler ön plandadır. İlk tanı anındaki semptomlardan bilhassa dışkıda kan ve klinik parametrelerden şiddet indexi, ülseratif kolitin takip sürecinde atak sayısının belirlenmesinde ve öngörülmesinde göz önünde bulundurulması gereken önemli kriterlerdir.

Keywords

Ülseratif Kolit, Atak, Klinik Parametreler

References

• 1) Ungaro R, Mehandru S, Allen PB, Peyrin-Biroulet L, Colombel JF. Ulcerative colitis. Lancet. 2017 Apr 29;389(10080):1756-1770.
• 2) Ordás I, Eckmann L, Talamini M, Baumgart DC, Sandborn WJ. Ulcerative colitis. Lancet. 2012 Nov 3;380(9853):1606-19.
• 3) Langholz E, Munkholm P, Davidsen M, Binder V. Course of ulcerative colitis: analysis of changes in disease activity over years. Gastroenterology. 1994 Jul; 107(1):3-11
• 4) Magro F, Rodrigues A, Vieira AI, Portela F, Cremers I, Cotter J, Correia L, Duarte MA, Tavares ML, Lago P, Ministro P, Peixe P, Lopes S, Garcia EB. Review of the disease course among adult ulcerative colitis population-based longitudinal cohorts. Inflamm Bowel Dis. 2012 Mar;18(3):573-83.
• 5) Reinisch W, Reinink AR, Higgins PD. Factors associated with poor outcomes in adults with newly diagnosed ulcerative colitis. Clin Gastroenterol Hepatol. 2015 Apr; 13(4):635-42.
• 6) Pabla BS, Schwartz DA. Assessing Severity of Disease in Patients with Ulcerative Colitis. Gastroenterol Clin North Am. 2020 Dec; 49(4): 671-688.
• 7) Walsh AJ, Ghosh A, Brain AO, Buchel O, Burger D, Thomas S, White L, Collins GS, Keshav S, Travis SP. Comparing disease activity indices in ulcerative colitis. J Crohns Colitis. 2014 Apr ;8(4) :318-25.
• 8) Silverberg M S, Satsangi J, Ahmad T.et al Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: Report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol 200519(suppl A)5–36.
• 9) Romberg-Camps MJ, Dagnelie PC, Kester AD, Hesselink-van de Kruijs MA, Cilissen M, Engels LG, et al. Influence of phenotype at diagnosis and of other potential prognostic factors on the course of inflammatory bowel disease. The American journal of gastroenterology. 2009;104(2):371-83.
• 10) Azad S, Sood N, Sood A. Biological and histological parameters as predictors of relapse in ulcerative colitis: a prospective study. Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association. 2011;17(3):194-8.
• 11) Henriksen M, Jahnsen J, Lygren I, Stray N, Sauar J, Vatn MH, et al. C-reactive protein: a predictive factor and marker of inflammation in inflammatory bowel disease. Results from a prospective population-based study. Gut. 2008 ;57(11) :1518-23.
• 12) Iwasa R, Yamada A, Sono K, Furukawa R, Takeuchi K, Suzuki Y. C-reactive protein level at 2 weeks following initiation of infliximab induction therapy predicts outcomes in patients with ulcerative colitis: a 3 year follow-up study. BMC gastroenterology. 2015;15:103.
• 13) Nishida Y, Hosomi S, Yamagami H, Yukawa T, Otani K, Nagami Y, et al. Neutrophil-to-Lymphocyte Ratio for Predicting Loss of Response to Infliximab in Ulcerative Colitis. PloS one. 2017;12(1) :e0169845.
• 14) Lynch RW, Churchhouse AM, Protheroe A, Arnott ID, Group UIAS. Predicting outcome in acute severe ulcerative colitis: comparison of the Travis and Ho scores using UK IBD audit data. Alimentary pharmacology & therapeutics. 2016 ;43(11) :1132-41.
• 15) Torun S, Tunc BD, Suvak B, Yildiz H, Tas A, Sayilir A, et al. Assessment of neutrophil-lymphocyte ratio in ulcerative colitis: a promising marker in predicting disease severity. Clinics and research in hepatology and gastroenterology. 2012 ;36(5) :491-7.
• 16) Cosnes J, Gower-Rousseau C, Seksik P, Cortot A. Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology. 2011 ;140(6) :1785-94.
• 17) Da Silva BC, Lyra AC, Rocha R, Santana GO. Epidemiology, demographic characteristics and prognostic predictors of ulcerative colitis. World journal of gastroenterology. 2014;20(28): 9458-67.
• 18) Solem CA, Loftus EV, Jr., Tremaine WJ, Harmsen WS, Zinsmeister AR, Sandborn WJ. Correlation of C-reactive protein with clinical, endoscopic, histologic, and radiographic activity in inflammatory bowel disease. Inflammatory bowel diseases. 2005;11(8):707-12
• 19) Turner D, Mack DR, Hyams J, LeLeiko N, Otley A, Markowitz J, et al. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) or both? A systematic evaluation in pediatric ulcerative colitis. Journal of Crohn's & colitis. 2011;5(5): 423-9.
• 20) Rodgers AD, Cummins AG. CRP correlates with clinical score in ulcerative colitis but not in Crohn's disease. Digestive diseases and sciences. 2007;52(9): 2063-8.
• 21) Prideaux L, Kamm MA, De Cruz PP, Chan FK, Ng SC. Inflammatory bowel disease in Asia: a systematic review. J Gastroenterol Hepatol 2012;27:1266-1280.
• 22) Hilmi I, Singh R, Ganesananthan S, et al. Demography and clinical course of ulcerative colitis in a multiracial Asian population: a nationwide study from Malaysia. J Dig Dis 2009;10:15-20.
• 23) Targownik LE, Singh H, Nugent Z, Bernstein CN. The epidemiology of colectomy in ulcerative colitis: results from a population-based cohort. Am J Gastroenterol 2012;107:1228-1235.
• 24) D’Haens G, Baert F, Van Assche G, et al. Early combined immunosuppression or conventional management in patients with newly diagnosed Crohn’s disease: an open randomised trial. The Lancet 2008; 371: 660-7.
• 25) Colombel JF, Rutgeerts P, Reinisch W, et al. Early mucosal healing with infliximab is associated with improved long-term clinical outcomes in ulcerative colitis. Gastroenterology 2011;141:1194-1201.
• 26) Colombel JF, Reinisch W, Mantzaris G, et al. Randomised clinical trial: deep remission in biologic and immunomodulator naïve patients with Crohn’s disease–a SONIC post hoc analysis. Aliment Pharmacol Ther 2015; 41 :734-46.