Ulcerative colitis is disabling over time

Understanding the natural history of ulcerative colitis (UC) is imperative especially in view of emerging therapies that could have the potential to alter the natural course of disease. Dr. Fumery and his colleagues are to be congratulated for conducting a comprehensive review of different inception cohorts across the world and evaluating different facets of the disease. They found that the majority of patients had a mild-moderate disease course, which was most active at the time of diagnosis. Approximately half the patients require UC-related hospitalization at some time during the course of their disease. Similarly, 50% of patients received corticosteroids, and while almost all patients with UC were treated with mesalamine within 1 year of diagnosis, 30%-40% are not on mesalamine long term. They also identified consistent predictors of poor prognosis, including young age at diagnosis, extensive disease, early need for corticosteroids, and elevated biochemical markers.

These results are reassuring because they reinforce the previous observations that roughly half the patients with UC have an uncomplicated disease course and that the first few years of disease are the most aggressive. A good indicator was that the proportion of patients receiving corticosteroids decreased over time. The disheartening news was that the long-term colectomy rates have generally remained stable over time.

The surprising aspect was the scarcity of data from North America; almost half the studies were from Scandinavian countries. There was also limited information on the impact of biologics and future research must be undertaken to evaluate their effect on the natural history of disease – especially the impact of early introduction among those who have poor prognostic features. This will go a long way in developing a personalized medicine approach in the management of UC.

Nabeel Khan, MD, is assistant professor of clinical medicine, University of Pennsylvania, Philadelphia, and director of gastroenterology, Philadelphia Veterans Affairs Medical Center. He has received research grants from Takeda, Luitpold, and Pfizer.