Review of the disease course among adult ulcerative colitis population-based longitudinal cohorts

Ulcerative colitis (UC) has a large impact on patients' lives. Clinical course studies of population-based cohorts contribute to our understanding of the disease as it progresses. We reviewed the clinical course of UC as reported in adult population-based longitudinal cohort studies.

A MEDLINE literature search to identify all adult population-based studies published up to June 2010 with data on the clinical course of UC was performed. Demographic and clinical data were reviewed.

Twenty-two studies reporting data from seven prospective longitudinal cohorts were identified. Extension from initial location varied from 10%-19% of the patients after 5 years of disease and from 11%-28% after 10 years in two of the cohorts. Disease activity appeared to improve over the disease course. The majority of patients had relapses in the first years of disease. The cumulative relapse rate varied from 67%-83% after 10 years of disease. From 1962-2004 a decreasing trend in the proportion of colectomies was observed. Most colectomies were performed during the first 2 years of disease and in patients with pancolitis. Salycilates were the most consumed medication followed by systemic steroids, immunosuppressors, and antitumor necrosis factors, with the latter two showing a substantial increased intake over time. Mortality increased with disease duration.

This review shows how the clinical course of UC has changed over time and alerts to the need for more prospective cohort studies to evaluate long-term outcomes especially to study the impact of biologic agents on UC.