Colorectal strictures in UC

April 20, 2021

Issue 08

Clinical Question

What are risk factors for colorectal strictures in ulcerative colitis?

Editor’s Bottom Line

Patients with extensive UC and those who require steroids are more likely to develop a colorectal stricture, which in turn is associated with a high risk of colorectal cancer.

Reference

Laurain P-A, Guillo L, D’Amico F, et al. Incidence of and Risk Factors for Colorectal Strictures in Ulcerative Colitis: A Multicenter Study. Clin Gastroenterol Hepatol. Epub ahead of print Jan 22, 2021; https://doi.org/10.1016/j.cgh.2021.01.028

Synopsis

Researchers set out to document rates of, and risk factors for, colorectal strictures in ulcerative colitis (UC) patients. To that end, they retrospectively examined data from all 439 adult patients treated for UC between 2004 and 2019 at a single hospital in Luxembourg. Patients were split roughly evenly by sex. Approximately 82% of patients received corticosteroids during the study period, while 75% received mesalamine, 62.5% received an anti-TNF agent, and 25% each received an immunosuppressant or vedolizumab.

The authors found that 3.6% of patients developed a colorectal stricture during a median 9.6 years of follow-up. The cumulative probability of developing a stricture was 1% and 2.3% at 5 and 10 years, respectively, following diagnosis.

Unlike the overall study population, who were a median 31 years of age at UC diagnosis, patients with strictures were a median 41 years of age at UC diagnosis and a median 48 years of age at the time of stricture diagnosis. The median time from UC diagnosis to stricture onset was 11.5 years.

In a multivariate analysis, independent predictors of a colorectal stricture included a Montreal A3 classification for disease extent (p=0.008) and corticosteroid use (Hazard Ratio [HR]: 4.1; 95% Confidence Interval [CI], 1.1–16.1; p=0.042), while treatment with mesalamine was associated with a 70% lower risk of strictures (HR: 0.3; 95% CI, 0.1–0.9; p=0.029). Over one-third of patients with a stricture developed colorectal cancer during follow-up.

Details

Study Design: Retrospective cohort

Funding: Not disclosed

Allocation: None

Setting: Multicenter

Level of Evidence: 2b