Describing Characteristics and Chronology of Ulcerative Colitis in African Americans

Abstract

To describe patient and disease characteristics, treatment response and outcome in African Americans (AA) with ulcerative colitis (UC). Single-center, retrospective study. We reviewed records of 50 AA patients with an established diagnosis of UC seen at the outpatient clinic between 2000 and 2009. Demographic and clinical variables were examined using descriptive statistics. The mean age at diagnosis was 37 years (range of 12-69 years). At the end of observation, mean duration of disease was 11 years and mean patient age was 47 years. Men and women were equally represented. The mean body mass index (BMI) was 28 mg/kg2. Twenty nine (73%) patients were overweight or obese. At diagnosis, 24 (48%) patients had pancolitis, 15 (30%) had left sided disease and 11 (22%) had proctitis/proctosigmoiditis. Nineteen (38%) patients had extra-intestinal manifestations which were predominantly rheumatologic (84%). Eight (20%) and 4 (10%) patients had family history of inflammatory bowel disease (IBD) and colorectal cancer respectively. Twenty three (46%) patients had a past history of 5-ASA agent use and 34 (68%) were on a 5-ASA agent at last observation. The most common reason for discontinuation of a 5-ASA agent was lack of response. Mesalamine Delayed-Release was overall the most common5-ASA agent used and 16 (57%) of the patients using a 5-ASA agent were on it at last observation. The second most common 5-ASA agent being used was sulfasalazine. Twelve (24%) patients had a past history of azathioprine/6-mercaptopurine (AZA/6-MP) use whereas six (12%) were on AZA/6-MP at last observation. Four (8%) patients had a past history of biologic use that included adalimumabor infliximab. Five (10%) patients were on a biologic at last observation. The two most common reasons for discontinuation of both AZA/6-MP and biologics were lack of response and intolerance. Seventeen (34%) patients had a significant history of steroid use with the mean duration of steroid use per year of 60 days. Eight (16%) patients had undergone total colectomy with ileal J pouch-anal anastomosis. The mean duration to surgery in these patients was 8 years. Calculation of average clinical disease activity during last year of observation revealed that 23 (46%) patients were in clinical remission, 15 (30%) had mild disease whereas 12 (24%) had moderate to severe disease. The corresponding last outpatient endoscopic evaluation revealed that 16 (36%) patients' disease was inactive, 14(32%) had mild mucosal disease whereas 14 (32%) patients had moderate to severe mucosal disease. None of the patients were found to have dysplasia and none died. Our study generally agrees with findings of previous studies done on AA patients with UC. These include a relatively low rate of steroid, traditional immune modulator and biologic use as well as a low rate of surgical intervention, with the rate of 5-ASA agent use being high. Notable difference includes an older age at diagnosis of UC in our cohort. At a given time, approximately 75% AA patients with UC are either in clinical remission or have mild clinical disease and 66% have inactive or mild mucosal disease.