Abstract
BackgroundExtraintestinal manifestations (EIM) are common in ulcerative colitis (UC). In Shanghai, China, data on the incidence rate and risk factors of EIM in UC patients remain scarce.MethodsThe study population consisted of UC patients who were identified from a prospectively maintained, institutional review board-approved database at our institutes from June 1986 to December 2018. The demographic and clinical characteristics of the study participants were analyzed. The study included secondary EIM in UC patients and follow-up, while primary EIM was excluded. The diagnosis of EIM was based on clinical, radiological, endoscopic, and immunologic examination and histological findings.ResultsIn total, 271 eligible patients were included in the current study, with a median follow-up time of 13.0 years (interquartile range, 9.0–17.0), and including 31 cases (11.4%) that developed EIM. EIM was associated with clinical outcomes in UC patients and the following factors were identified as contributing factors for the development of EIM: a disease duration of >5 years (odds ratio (OR), 3.721; 95% confidence interval (CI) [1.209–11.456]), age at diagnosis >40 years (OR, 2.924, 95% CI [1.165–7.340]), refractory clinical symptoms (OR, 4.119; 95% CI [1.758–9.650]), and moderate or severe anemia (OR, 2.592; 95% CI [1.047–6.413]).ConclusionIn this study, approximately 11.4% UC patients go on to develop at least one EIM. Clinicians should prioritize early control of the disease and treatment of anemia in UC in order to prevent the development of EIM and improve disease prognosis.
Highlights
As a major form of inflammatory bowel disease (IBD), ulcerative colitis (UC) is a multifactorial polygenic disease with probable genetic heterogeneity, which is characterized by a chronic course of recurrent relapse and remission (Fiocchi, 1998; Podolsky, 2002; SC, 2017)
Demographics and clinical characteristics A total of 291 UC patients were enrolled at our institute, 20 patients were lost to follow-up and excluded; 271 eligible patients were included for the current research
The major findings of this study can be summarized as follows: (1) The overall incidence rate of Extraintestinal manifestations (EIM) of UC in Shanghai was 11.4%. (2) Patients with EIM had worse clinical outcomes, which mainly presented as lower remission rates, increased incidence of serious complications, and more likely to develop colorectal cancer (CRC). (3) A disease duration >5 years, an age at diagnosis >40 years, refractory clinical symptoms, and moderate or severe anemia contributed to the development of EIM
Summary
As a major form of inflammatory bowel disease (IBD), ulcerative colitis (UC) is a multifactorial polygenic disease with probable genetic heterogeneity, which is characterized by a chronic course of recurrent relapse and remission (Fiocchi, 1998; Podolsky, 2002; SC, 2017). The clinical presentation of EIM is extremely heterogeneous and can affect almost all of the organs in the body; EIM is especially involved in blood, joints, skin, eyes, biliary tracts, the vascular system, and organs such as the liver, kidneys, and lungs Some diseases, such as oral aphthous ulcers and erythema nodosum, parallel the activity of the bowel disease, but for a number of these conditions, such as ankylosing spondylitis, they follow an independent course from the disease activity of UC (Rothfuss, Stange & Herrlinger, 2006; Trikudanathan, Venkatesh & Navaneethan, 2012). Clinicians should prioritize early control of the disease and treatment of anemia in UC in order to prevent the development of EIM and improve disease prognosis
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