Acute Severe Ulcerative Colitis Patients From Asia Have Lower Colectomy Risk Than Patients From Australasia

Area of Science:

• Gastroenterology
• Clinical Epidemiology
• Inflammatory Bowel Disease Research

Background:

• Incidence of ulcerative colitis (UC) and acute severe ulcerative colitis (ASUC) is rising in Asia, yet remains lower than in Australia and New Zealand (ANZ).
• Asian studies indicate unique UC characteristics and a lower risk of colectomy.
• Significant regional variations in ASUC necessitate comparative studies.

Purpose of the Study:

• To compare the clinical characteristics and treatment outcomes of acute severe ulcerative colitis (ASUC) patients in Asia versus ANZ.
• To identify differences in disease presentation, management, and colectomy rates between these geographic regions.

Main Methods:

• Multinational, multicenter retrospective cohort study.
• Inclusion of consecutive patients hospitalized with ASUC (Truelove and Witts' criteria) from January 2015 to December 2020.
• Data collected from 14 hospitals in 4 Asian countries and 9 ANZ hospitals.

Main Results:

• 861 patients included (430 Asia, 431 ANZ) with differing baseline characteristics.
• Asian cohort presented with more extensive disease and worse endoscopic severity but lower IBD family history.
• Asian patients received less pre-admission advanced therapies, showed lower corticosteroid failure rates (21.5% vs 57.2%), and significantly reduced inpatient (2.8% vs 10.9%) and 1-year colectomy rates (4.7% vs 22.5%).

Conclusions:

• Significant differences exist in ASUC patient characteristics between Asia and ANZ.
• Despite more severe disease presentation, the Asian ASUC cohort demonstrates superior corticosteroid responsiveness.
• Lower colectomy rates and reduced reliance on advanced therapies are observed in Asian ASUC patients compared to ANZ.