Natural course of ulcerative colitis in China: Differences from the West?

IF 5.8 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY United European Gastroenterology Journal Pub Date : 2024-11-01 Epub Date: 2024-07-19 DOI:10.1002/ueg2.12634
Jian Wan, Jun Shen, Jie Zhong, Wensong Ge, Yinglei Miao, Xiaolan Zhang, Zhonghui Wen, Yufang Wang, Jie Liang, Kaichun Wu
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Abstract

Background and aims: Whether the natural course of ulcerative colitis (UC) in mainland China is similar or different from that in Western countries is unknown, and data on it is limited. We aimed to provide a comprehensive description of the natural course of UC in China and compare it with Western UC patients.

Methods: Based on a prospective Chinese nationwide registry of consecutive patients with inflammatory bowel diseases, the medical treatments and natural history of UC were described in detail, including disease extension, surgery, and neoplasia. The Cox regression model was used to identify factors associated with poor outcomes.

Results: A total of 1081 UC patients were included with a median follow-up duration of 5.3 years. The overall cumulative exposure was 99.1% to 5-aminosalicylic acids, 52.1% to corticosteroids, 25.6% to immunomodulators, and 15.4% to biologics. Disease extent at diagnosis was proctitis in 26.9%, left-sided colitis in 34.8%, and extensive colitis in 38.3%. Of 667 patients with proctitis and left-sided colitis, 380 (57.0%) experienced disease extent progression. A total of 58 (5.4%) UC patients underwent colectomy, demonstrating cumulative proportions of surgery at 1, 5, and 10 years after diagnosis of 0.6%, 3.4%, and 8.2%, respectively. In addition, 23 (2.1%) UC patients were diagnosed with neoplasia, demonstrating cumulative proportions of neoplasia at 1, 5, and 10 years after diagnosis of 0.5%, 1.0%, and 3.5%, respectively.

Conclusions: Chinese UC patients had similar cumulative proportions of exposure to IBD-specific treatments but a lower surgical rate than patients in Western countries, indicating a different natural course, and close monitoring needs for UC in China. However, these results must be confirmed in population-based studies because the hospital-based cohort in our study might lead to selection bias.

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中国溃疡性结肠炎的自然病程:与西方的差异?
背景和目的:中国大陆溃疡性结肠炎(UC)的自然病程与西方国家是否相似或不同尚不清楚,相关数据也很有限。我们旨在全面描述中国 UC 的自然病程,并将其与西方 UC 患者进行比较:方法:基于一项前瞻性的中国全国性炎症性肠病患者登记,详细描述了 UC 的药物治疗和自然病史,包括疾病扩展、手术和肿瘤。采用 Cox 回归模型确定与不良预后相关的因素:结果:共纳入1081名UC患者,中位随访时间为5.3年。5-氨基水杨酸、皮质类固醇、免疫调节剂和生物制剂的总累积接触率分别为99.1%、52.1%、25.6%和15.4%。确诊时疾病程度为直肠炎的占 26.9%,左侧结肠炎的占 34.8%,广泛性结肠炎的占 38.3%。在 667 名患有直肠炎和左侧结肠炎的患者中,有 380 人(57.0%)的病情有所进展。共有 58 名(5.4%)UC 患者接受了结肠切除术,确诊后 1 年、5 年和 10 年的累计手术比例分别为 0.6%、3.4% 和 8.2%。此外,23 例(2.1%)UC 患者被确诊为肿瘤,确诊后 1 年、5 年和 10 年的肿瘤累计比例分别为 0.5%、1.0% 和 3.5%:结论:与西方国家相比,中国UC患者接受IBD特异性治疗的累积比例相似,但手术率较低,这表明中国UC的自然病程不同,需要密切监测。然而,这些结果必须在基于人群的研究中得到证实,因为我们的研究中基于医院的队列可能会导致选择偏倚。
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来源期刊
United European Gastroenterology Journal
United European Gastroenterology Journal GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
10.50
自引率
13.30%
发文量
147
期刊介绍: United European Gastroenterology Journal (UEG Journal) is the official Journal of the United European Gastroenterology (UEG), a professional non-profit organisation combining all the leading European societies concerned with digestive disease. UEG’s member societies represent over 22,000 specialists working across medicine, surgery, paediatrics, GI oncology and endoscopy, which makes UEG a unique platform for collaboration and the exchange of knowledge.
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