Risk factors and long-term prognosis for colorectal strictures in ulcerative colitis

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Inflammatory Bowel Disease Research

Background:

• Colorectal strictures are uncommon in ulcerative colitis (UC) but linked to heightened malignancy and complication risks.
• Fibrogenesis and stricture development in UC have been under-researched.
• Understanding stricture incidence and risk factors is crucial for UC patient management.

Purpose of the Study:

• To determine the incidence and long-term prognosis of colorectal strictures in a large UC patient cohort.
• To identify key risk factors associated with stricture formation in UC.
• To analyze the impact of strictures on patient outcomes, including complications, surgery, and mortality.

Main Methods:

• A retrospective analysis of 938 hospitalized UC patients from 2014-2024.
• Strictures defined as fixed, localized colorectal lumen narrowing.
• Multivariable Cox regression identified risk factors; Kaplan-Meier and Fine-Gray methods analyzed prognosis.
• Sensitivity analysis excluded malignant strictures to focus on UC-specific pathophysiology.

Main Results:

• Overall stricture incidence was 12.4% with a 10-year cumulative probability of 11.3%.
• UC patients with strictures faced higher risks of intestinal complications, surgery (37.6% 10-year probability), and malignancy (8.6% of cases).
• Age ≥ 40 at diagnosis and extraintestinal manifestations increased stricture risk, while vedolizumab use showed a protective effect.

Conclusions:

• Ulcerative colitis patients with colorectal strictures experience poorer long-term outcomes.
• Consider earlier endoscopic surveillance for UC patients aged 40 or older.
• Biologic therapy and monitoring for extraintestinal manifestations are advised for high-risk UC patients.