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Five-Year Outcomes and Disease Trajectories in Moderate-to-Severe Ulcerative Colitis: A Korean Multicenter Inception
Byong Duk Ye1, Hyo Jong Kim2, Dong Il Park3
1Department of Gastroenterology and Inflammatory Bowel Disease Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Journal of Gastroenterology and Hepatology
|June 29, 2026
Summary
In Korean patients with moderate-to-severe ulcerative colitis (UC), nearly half experienced a disabling disease course despite low colectomy rates. Elevated white blood cell counts predicted a worse outcome, highlighting the need for personalized UC management.
Area of Science:
- Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Epidemiology
Background:
- Ulcerative colitis (UC) incidence is rising in Asia, yet long-term data for moderate-to-severe cases are limited.
- Understanding the disease trajectory in this population is crucial for effective management.
Purpose of the Study:
- To investigate clinical outcomes in Korean patients with moderate-to-severe UC.
- To identify factors associated with a disabling disease course over five years.
Main Methods:
- Prospective, multicenter, hospital-based inception cohort study.
- Enrolled 353 newly diagnosed moderate-to-severe UC patients (August 2014 - February 2017).
- Evaluated clinical outcomes and disabling disease course factors over a 5-year follow-up.
Main Results:
- At 5 years, cumulative rates included clinical relapses (62.9%), proximal disease extension (29.5%), and UC hospitalization (22.4%).
- Colectomy rate was low (0.6%) with no mortality.
- A disabling disease course affected 48.4% of patients; elevated baseline white blood cell count was an independent predictor (aHR: 1.06).
- Five distinct disease trajectory clusters were identified.
Conclusions:
- Korean patients with moderate-to-severe UC exhibit a benign structural course but a high rate of disabling disease.
- Disease trajectories offer a framework for risk stratification and personalized UC management.
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