Issue 06

Clinical Question

In patients with confirmed ulcerative colitis (UC), does segmental distribution of disease predict outcomes?

Editor’s Bottom Line

UC patients with segmental disease or rectal sparing have a more severe disease and shorter time to colectomy.

Reference

Uchida K, Araki T, Hashimoto K, et al. Segmental distribution in refractory ulcerative colitis: a histological evaluation in pediatric and adult patients who underwent proctocolectomy. Inflamm Bowel Dis. 2014 Jul;20(7):1227–35.  https://www.ncbi.nlm.nih.gov/pubmed/24865779

Synopsis

The retrospective study was comprised of 14 patients with childhood onset of UC (CUC) and 76 patients with adult onset of UC (AUC). All patients had medically refractory disease and had undergone total proctocolectomy/IPAA. Medical records were reviewed for disease history, medications, and clinical features in addition to histology and pathology reports of the resected colon specimens. There were no differences between CUC and AUC patient groups other than age of onset and age of surgery.

The percent of patients with segmental disease was 64% in the CUC group and 21% in the AUC group (P=0.0009).

Patients with segmental disease had a shorter time before surgery (4.4 vs. 8.2 years, P=0.0009), more males (68% vs. 43%, P=0.0342), and more severe pathological disease activity (P=0.0390). Logistic regression found that segmented distribution of disease gave an odds ratio of 6.5591 for early time to surgery (95% CI: 1.8897–22.7661; P=0.0031).

Details

Study Design: Retrospective analysis
Funding: None reported
Allocation: n/a
Setting: Single centre, Japan
Level of Evidence: 2b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.