Mortality In Ulcerative Colitis Research Articles

S11 Impact of Marijuana in Ulcerative Colitis With Nstemi Hospitalizations: Insights From National Inpatient Sample 2016-2019.

Background: Marijuana use is increasingly prevalent in patients with ulcerative colitis (UC). Clinical symptoms such as abdominal pain, reduced appetite, and diarrhea improve in some patients after marijuana use; partly due to its psychotropic, neuromodulatory, and immunomodulatory effects via the endocannabinoid pathway. Marijuana use and underlying UC can lead to adverse cardiovascular outcomes, and we aim to study its impact on NSTEMI hospitalizations. Methods: A retrospective analysis of the 2016-2019 NIS was conducted to identify hospitalization (Age ≥18 & non-elective) with acute NSTEMI and concomitant history of UC using ICD-10 codes. Variables were screened with univariate regression, intermediate, co-linear variables were removed before a multivariable regression analysis model was built and performed to calculate the odds ratio. Discharge-level weight analysis was used to produce a national estimate. Results: Out of 142,420,378 hospitalizations, only 7,010 had acute NSTEMI and underlying UC. Only 0.78% of these hospitalizations also reported marijuana use. The mean age of patients who used marijuana was 57.55 yrs vs 70.58 yrs for those who did not. A total of 560 (7.99%) hospitalizations had fatal outcomes; however, the difference in deaths between those who used marijuana vs those who did not was statistically insignificant (9.09% vs 7.99%, P 0.89). Upon multivariate analysis, marijuana is not a risk factor for mortality in UC + NSTEMI (OR 1.11, P 0.907). Factors associated with increased mortality were shock (OR 5.88, P 0.00), AKI (OR 3.44, P 0.00), mech ventilation > 24h (OR 3.44, P 0.00). Marijuana use is also not associated with increased hospital resource utilization (-22557.46$, P 0.42). Factors associated with increased total charges of hospitalization are urban teaching hospital location (rural -48272.37$ p 0.00, urban non-teaching -23378.35$, P 0.00), mech ventilation >24 hr (+170339.6$, P 0.00), HF (+25197.46$, P 0.00), CABG (+152736.6$, P 0.00), and shock (+50532.01$, P 0.000). Marijuana, however, is associated with a lower mean length of stay (LOS) by 3.4 days (P 0.02). Factors associated with higher mean LOS are elixhauser comorbidity (+0.48d, P 0.00), mech ventilation > 24h (+7.35d, P 0.00), shock (+1.72d, p 0.01), ventricular arrhythmias (+1.90d, P 0.02), ESRD on HD (+5.20d, P 0.04), AKI (+2.11d, P 0.00), CABG (+5.62d, P 0.000), and anemia (+1.09d, P 0.02). Conclusion(s): Marijuana is not associated with increase in mortality or total charges of hospitalization in UC patients admitted for acute NSTEMI. Additionally, it is associated with reduced LOS in these hospitalizations, likely due to the lower mean age resulting in quicker recovery and discharge.

Hospital Mortality Trends of Inflammatory Bowel Disease

Introduction: Recent studies have indicated the increasing rates of hospitalization among the Inflammatory bowel disease(IBD) patients. With rapidly improving treatment regimens for Inflammatory Bowel Disease(IBD), patients are expected to live longer. We sought to determine whether the mortality has improved over the last ten years. We also aim to determine the factors associated with mortality. Methods: National Inpatient Sample data from 2005 to 2014 was used to assess the trends. Logistic regression analysis was used to assess the various factors association with mortality. Results: 1.IBD as one of the Diagnosis: 8860 (1.6%) of 552887 IBD hospitalizations ended in death. Age-adjusted mortality increased from 608 deaths per 100,000 admissions in 2005 to 816 in 2014, peaked to 915 in 2008. Similar trends were seen in both Ulcerative colitis(UC) and Crohn's disease(CD). Mortality was high for UC than the CD (1071 vs 619 per 100,000 admissions, OR 1.71,95% CI 1.5 to 1.9, P < 0.001). On Logistic regression, Mortality is associated with Advanced age, longer Length of stay, septicemia, higher Deyo modified Charlson Comorbidity Index score, Clostridium Difficile infection, UC. Race and Sex have no effect on mortality, Obesity appears to be protective. A similar association was observed in both the UC and CD subgroups, except Female sex appears to be protective in CD. Clostridium difficile infection is associated with higher mortality in UC than Crohn's. 2.IBD as primary Diagnosis: 862 (0.5%) of 181224 admissions ended in death. The age-adjusted mortality decreased from 553 per 100,000 admissions in 2005 to 232 in 2014. Similar trends were seen in the both UC and Crohn's groups. Mortality in UC subgroup is higher than the Crohn's, OR 1.98, P < 0.001 On logistic regression, Septicemia, advanced age, longer Length of stay, higher Deyo Modified Charlson Index, Clostridium difficile infection, UC is associated with higher mortality. Obesity and Calendar year appears to be protective. The most common primary Diagnosis for IBD patient's admission is IBD followed by Intestinal obstruction without Hernia, Septicemia, for the patient with mortality is Septicemia, IBD, Respiratory Failure, Intestinal Infection, Pneumonia. Conclusion: The hospital mortality rates have improved in patients with IBD as the primary diagnosis but not in the patients with any primary diagnosis in this large national hospital database.Figure: Mortality trends Total IBD admissions vs admission with IBD as primary Diagnosis.Figure: Ulcerative Colitis and Crohns mortality trends.Figure

PTU-107 Comparison Of Mortality Following Hospitalisation For Ulcerative Colitis In Scotland Between 1998–2000 And 2007–2009

IntroductionWe have previously demonstrated concerningly high 3-year mortality following hospitalisation with ulcerative colitis (UC) between 1998 and 2000 in Scotland.1 We have extended these studies by examining 3-year mortality following...

Mortality in inflammatory bowel disease patients under 65 years of age

Objective. To assess mortality in inflammatory bowel disease (IBD) patients under 65 years of age and to identify the factors related to death in this age group. Methods. We studied 2570 IBD patients who were diagnosed as having disease before 65 years of age and attended a single tertiary referral center area between 1983 and 2012. Follow-up was censored at 65 years. The causes of death were determined from death certificates obtained from the Irish registry office of births, marriages and deaths. Observed all-cause survival was compared with expected survival of persons of the same age and sex in the general population. Expected survival was obtained from national life tables produced by the central statistics office. Survival estimates were calculated for disease type, disease site, gender, the presence of primary sclerosing cholangitis (PSC), immunomodulator use, biologic therapy use, presence of fistulating disease and prior surgery. Results. Fifty-two deaths were reported in the population younger than 65 years, of which 41 were IBD related. We found little difference in survival in the first 25 years of follow-up, but relative survival decreased in both the Crohn's disease (CD) and ulcerative colitis (UC) cohort thereafter, so that 30-year mortality was excessive in both groups. An adjusted multivariate regression analysis of patients with CD identified PSC as the only predictor of premature mortality (p = 0.003). PSC was also identified as the only independent predictor of mortality in UC patients (p = 0.03). Conclusions. The presence of PSC poses the greatest risk for mortality in both UC and CD.

Ulcerative colitis-associated colorectal cancer.

The association between ulcerative colitis (UC) and colorectal cancer (CRC) has been acknowledged. One of the most serious and life threatening consequences of UC is the development of CRC (UC-CRC). UC-CRC patients are younger, more frequently have multiple cancerous lesions, and histologically show mucinous or signet ring cell carcinomas. The risk of CRC begins to increase 8 or 10 years after the diagnosis of UC. Risk factors for CRC with UC patients include young age at diagnosis, longer duration, greater anatomical extent of colonic involvement, the degree of inflammation, family history of CRC, and presence of primary sclerosing cholangitis. CRC on the ground of UC develop from non-dysplastic mucosa to indefinite dysplasia, low-grade dysplasia, high-grade dysplasia and finally to invasive adenocarcinoma. Colonoscopy surveillance programs are recommended to reduce the risk of CRC and mortality in UC. Genetic alterations might play a role in the development of UC-CRC. 5-aminosalicylates might represent a favorable therapeutic option for chemoprevention of CRC.

Letter: acute severe ulcerative colitis - should all patients be treated equally? Authors' reply

We would like to thank Barreiro-de Acosta and Gisbert for their interest in our article.1, 2 The mortality we observed in the elderly acute severe ulcerative colitis (ASUC) population was striking, with a 13-fold and 28-fold increased risk of death in those patients over 60 in 2008 and 2010 respectively.2 This higher mortality in the elderly has been previously reported and was recently summarised in a review of mortality in ulcerative colitis (UC).3 In addition, our finding of increasing mortality in patients with comorbidities might go some way in explaining the higher mortality in elderly patients. It is of note, however, that age and comorbidity have previously been shown to be independent risk factors for mortality in UC.4 A recent report by Charpentier et al. suggests that elderly UC patients' presentations are phenotypically different, with milder disease at presentation, but with earlier progression to colectomy when compared with younger patients;5 could this be relevant in the increased mortality observed? As patients survive longer and present with evermore complex comorbidities, these findings will certainly be relevant in future ASUC management. We would also agree that it is important to at least consider medical rescue therapy in all ASUC patients failing steroid therapy as we have not demonstrated increased short-term mortality when compared with surgery.2 Similar to Nørgård et al.,6 we have demonstrated, in unpublished work from this cohort, that there is no increase in short-term complications in patients who undergo surgery following rescue medical therapy.7 However, it is important to emphasise that our follow-up extends only to hospital discharge. The cornerstone of high-quality care in ASUC continues to be a multidisciplinary approach, with decisions being made promptly and with the appropriate involvement of all members, including patients. The authors' declarations of personal and financial interests are unchanged from those in the original article.2

Su1184 Impact of Ulcerative Colitis on Patient Quality of Life in a Real-World Clinical Setting

a single tertiary referral centre between 1983 and 2012. Follow up was censored at 65 years and the overall follow-up included 22,965 patient years. Causes of death were determined from death certificates obtained from the Irish registry office of births, marriages and deaths. Observed all-cause survival was compared with expected survival of persons of the same age and sex in the general population (for each year of follow-up). Expected survival (annual survival probability by single year of age) was obtained from national life tables produced by the central statistics office. Survival estimates were calculated for disease type, disease site, gender, the presence of primary sclerosing cholangitis (PSC), immunomodulator use, biologic therapy use, presence of fistulating disease and prior surgery. Results: There were 52 deaths in the under 65 year old population, of which 40 were directly or indirectly related to inflammatory bowel disease. The 20 and 40 year relative survival rate for Crohn’s disease patients was 97.7% and 77.4% respectively and for ulcerative colitis patients was 98.6% and 86.9%. An adjusted multivariate regression analysis of patients with Crohn’s disease that included age, gender, disease site, surgery, presence of PSC and medication use identified PSC as the only predictor of premature mortality (p = 0.003). PSC was also identified as the only independent predictor of mortality in ulcerative colitis patients (p = 0.03). Conclusions: 20 year survival for both Crohn’s disease and ulcerative colitis patients is similar to that of the general population, but 40 year mortality is excessive in both groups. The presence of PSC poses the greatest risk for mortality in both ulcerative colitis and Crohn’s disease.

Mo1370 Incidence and Predictors of Early Readmission in Patients With Severe Ulcerative Colitis: Results From a Tertiary Care Center

Introduction: A number of studies have assessed survival in inflammatory bowel disease patients when compared with the general population, however, none has focussed on mortality on younger patients. Aim: To assess mortality in IBD patients under 65 years relative to the normal population and identify factors related to death in this age group. Methods: We studied 2,570 IBD patients diagnosed before 65 years (mean age 32 years at diagnosis; 1265 male) attending a single tertiary referral centre between 1983 and 2012. Follow up was censored at 65 years and the overall follow-up included 22,965 patient years. Causes of death were determined from death certificates obtained from the Irish registry office of births, marriages and deaths. Observed all-cause survival was compared with expected survival of persons of the same age and sex in the general population (for each year of follow-up). Expected survival (annual survival probability by single year of age) was obtained from national life tables produced by the central statistics office. Survival estimates were calculated for disease type, disease site, gender, the presence of primary sclerosing cholangitis (PSC), immunomodulator use, biologic therapy use, presence of fistulating disease and prior surgery. Results: There were 52 deaths in the under 65 year old population, of which 40 were directly or indirectly related to inflammatory bowel disease. The 20 and 40 year relative survival rate for Crohn's disease patients was 97.7% and 77.4% respectively and for ulcerative colitis patients was 98.6% and 86.9%. An adjusted multivariate regression analysis of patients with Crohn's disease that included age, gender, disease site, surgery, presence of PSC and medication use identified PSC as the only predictor of premature mortality (p=0.003). PSC was also identified as the only independent predictor of mortality in ulcerative colitis patients (p=0.03). Conclusions: 20 year survival for both Crohn's disease and ulcerative colitis patients is similar to that of the general population, but 40 year mortality is excessive in both groups. The presence of PSC poses the greatest risk for mortality in both ulcerative colitis and Crohn's disease.

Mortality in ulcerative colitis and Crohn's disease. A population-based study in Finland

BackgroundAn increased mortality has been reported in patients with Crohn's disease (CD), while figures have remained similar or decreased in patients with ulcerative colitis (UC) compared to the population in general. We evaluated the long-term mortality risk of patients with inflammatory bowel diseases (IBD) in a well-defined population. MethodsThe data were based on a prospective IBD register in our catchment area; follow-up covered 1986–2007. The population based cohort comprised 1915 adult patients, 1254 with UC, 550 with CD, and 111 with inflammatory bowel disease unclassified (IBDU). The mortality rate and causes of death were obtained from Statistics Finland. ResultsWe recorded 223 deaths among the 1915 patients with IBD within a follow-up of 29,644 person-years. The standardised mortality rate (SMR) was 1.14 in CD and 0.90 in UC. In cause-specific mortality; the risk of death in diseases of the digestive system was significantly increased in CD (SMR 5.38). The mortality in colorectal cancer was non-significantly increased in both UC and CD (SMR 1.80 and 1.88, respectively). Compared to the background population, there were significantly fewer deaths due to mental and behavioural disorders due to use of alcohol (0 observed, 10.2 expected in IBD). ConclusionsThe overall mortality in CD and CU was not different from that in the population. In cause-specific mortality, diseases of the digestive system were significantly increased. Deaths due to mental and behavioural disorders resulting from alcohol consumption were less common in patients with IBD than in the population at large in Finland.

Nationwide linkage analysis in Scotland implicates age as the critical overall determinant of mortality in ulcerative colitis

Recent data associated higher mortality with medical rather than surgical intervention in patients with ulcerative colitis who require hospitalization. To examine factors influencing UC-related mortality in Scotland. Using the national record linkage database 1998-2000, 3-year mortality was determined after four admission types: colectomy-elective or emergency; no colectomy-elective or emergency. Of 1078 patients, crude 3-year mortality rates were: colectomy elective 5.6% (n = 177) and emergency 9.0% (100); no colectomy elective 9.8% (244) and emergency 16.0% (557). Using elective colectomy as reference, multivariate analysis [OR (95% CI)] showed that admission age >50 years [OR 5.46 (2.29-11.95)], male gender [OR 1.92 (1.23-3.02)], comorbidity [OR 2.2 (1.38-3.51)], length of stay >15 days [OR 2.04 (1.08-3.84)] and prior IBD admission [OR 1.66 (1.06-2.61)] were independently related to mortality. Age was the strongest determinant. No patient <30 years died. Mortality of patients aged <50 years [10/587 (1.7%)] was significantly lower than mortality of those aged 50-64 years [26/246 (10.6%)] (chi(2) = 32.91; P < 0.0000001) and >65 [96/245 (39.2%)] (chi(2) = 218.2; P < 0.0000001). For those patients aged more than 65 years, mortality in the four groups was 29.4%, 33.3%, 28.1% and 44.7%- all greater than expected in the Scottish population on assessment of standardized mortality ratios. Hospital admission in UC patients >65 is associated with high mortality. Management strategies should consider this by treatment in specialist units, early investigation, focused medical treatment and earlier surgical referral.

PWE-029 Nationwide linkage analysis in Scotland implicates age as the critical overall determinant of mortality in ulcerative colitis

<h3>Introduction</h3> Mortality rates of patients hospitalised with ulcerative colitis (UC) were defined to identify important risk factors. <h3>Methods</h3> A cohort study was undertaken using the Scottish national record linkage database. Three-year mortality rates of patients with a primary diagnosis of UC between 1998 and 2000 were determined according to the type of admission: colectomy elective, colectomy emergency, no colectomy elective and no colectomy emergency. Univariate and multivariate analyses were used to determine the influence of age, gender, comorbidity, interval from admission to surgery, social deprivation, length of stay and type of hospital. <h3>Result</h3> Of 1078 patients identified (90.9% audit completeness), 177 were coded as colectomy elective, 100 as colectomy emergency, 244 as no colectomy elective and 557 as no colectomy emergency. Crude three-year mortality rates were 5.6%, 9.0%, 9.8% and 16.0%. Male gender, comorbidity and length of stay were each independently related to mortality on multivariate analysis. Age was the critical determinant of mortality; no patient aged &lt;30 years died; mortality in the under 50s (10/587 (1.7%)) was significantly lower than for those aged 50–64 years (26/246 (10.6%)) (χ²=32.91, p&lt;0.0000001) and 65 years and above (96/245 (39.2%)) (χ²=218.2, p&lt;0.0000001). There was no significant difference in mortality by admission type under 65 years. At 65 years and beyond the three year mortality in the four admission groups was 29.4%, 33.3%, 28.1% and 44.7%. <h3>Conclusion</h3> Three-year mortality after an incident admission for UC is high over 65 years and is highest for emergency admissions not undergoing surgery. Management protocols in the elderly should be reconsidered in the light of these data.

Mortality in ulcerative colitis—what should we tell our patients? Three year mortality following admission for the treatment of ulcerative colitis: a 6 year retrospective case review

ObjectivesTo determine the 3 year mortality of patients admitted to hospital for the treatment of ulcerative colitis (UC).DesignRetrospective case note review of all patients admitted to hospital for treatment of...

Review: Current trends in inflammatory bowel disease: the natural history

The description of the prognosis of inflammatory bowel disease (IBD) is based on systematic follow-up of population-based cohorts. A steady increase in incidence of IBD has occurred. The distribution of ulcerative colitis (UC) is fairly uniform with a preponderance of left-sided disease. One-third of Crohn's disease (CD) patients present with colonic disease, one-third with ileocolonic disease and one-third with small bowel disease. IBD is associated with extra-intestinal manifestations (EIMs) in up to 36% of patients. Uveitis and episcleritis are the most common. The cumulative probability of a relapsing course in UC is 90% after 25 years. In CD disease behaviour varies substantially with time. At diagnosis behaviour is inflammatory in 70% of patients. At follow-up there is a change to either stricturing or penetrating disease. Most patients with CD will eventually require surgery. Risk factors for CD recurrence after surgery include penetrating/fistulizing disease behaviour, young age, short duration of disease before first surgery and ileocolonic disease. The incidence of colorectal cancer (CRC) in UC seems to be decreasing. The risk of CRC in CD seems to be equivalent to the risk in UC. Patients with small bowel CD are also at increased risk of small bowel adenocarcinoma. CD is associated with a mortality rate 20-70% higher than expected, whereas mortality in UC is equivalent to that of the general population. The improved prognosis of IBD, especially UC, could be due to a chemopreventive effect of the medications used. Further studies are needed to develop the best strategy for the reduction of mortality and cancer risk in IBD.

Overall and Cause-Specific Mortality in Ulcerative Colitis: Meta-analysis of Population-Based Inception Cohort Studies

It remains debated whether patients with ulcerative colitis (UC) are at greater risk of dying and whether a possible alteration in mortality can be attributed to specific causes of death. We aimed to clarify this issue by conducting a meta-analysis of population-based inception cohort studies on overall and cause-specific mortality in patients with UC. The MEDLINE search engine and abstracts from international conferences were searched for relevant literature by use of explicit search criteria. STATA meta-analysis software was used to calculate pooled risk estimates (SMR, standardized mortality ratio, observed/expected deaths) of overall mortality and specific causes of death and to conduct metaregression analyses of the influence of specific variables on SMR. Ten papers fulfilled the inclusion criteria, reporting SMRs varying from 0.7 to 1.4. The overall pooled estimate was 1.1 (95% confidence interval [CI] 0.9-1.2, P= 0.42). However, greater risk of dying was observed during the first years of follow-up, in patients with extensive colitis, and in patients from Scandinavia. Metaregression analysis showed an increase in SMR by increasing cohort size. UC-related mortality accounted for 17% of all deaths. Mortality from gastrointestinal diseases, nonalcoholic liver diseases, pulmonary embolisms, and respiratory diseases was increased whereas mortality from pulmonary cancer was reduced. The overall risk of dying in patients with UC did not differ from that of the background population, although subgroups of patients were at greater risk of dying. The cause-of-death distribution seemed to differ from that of the background population.

Ulcerative colitis with low-grade dysplasia

37-year-old woman with a 17-year history of ulerative colitis that extends up to the mid-descendng colon undergoes routine surveillance colonosopy. Her disease is quiescent at the time of the rocedure (and has been for 5 years) and no lesions r masses are identified. Thirty-six biopsies are aken from 10-cm intervals up to the cecum. Histoogical exam reveals findings consistent with idioathic inflammatory bowel disease in the rectum, igmoid colon, and descending colon. Three biopies from her sigmoid colon are reported as lowrade dysplasia. The biopsies are sent to a local niversity pathologist with a special interest in GI athology, and she suggests that the biopsies are ndeterminate for dysplasia. The patient returns for repeat dysplasia surveillance endoscopy 3 months ater and 8 extra biopsies are obtained from the igmoid and descending colon. Four biopsies from er sigmoid colon are identified as containing lowrade dysplasia, and there is agreement between the pathologists.

Survival and cause-specific mortality in ulcerative colitis: follow-up of a population-based cohort in Copenhagen County

Background & Aims : A population-based cohort from Copenhagen County comprising 1160 patients diagnosed with ulcerative colitis between 1962 and 1987 was followed-up until 1997 to describe survival and cause-specific mortality. Methods : Observed vs. expected deaths were presented as standardized mortality ratio (SMR) with exact 95% confidence intervals (CI) calculated by using individually registered person-years at risk and Danish 1995 mortality rates. Cumulative survival curves were calculated. Results : A total of 261 deaths occurred, not significantly different from the expected number of 249 (SMR, 1.05; 95% CI, 0.92–1.19). The median age at death among men was 70 years (range, 6–96 years) and among women 74 years (range, 25–96 years). Twenty-five deaths (9.6%) were caused by complications to ulcerative colitis, mostly infectious and cardiovascular postoperative complications. Patients older than 50 years of age at diagnosis and with extensive colitis showed an increased mortality within the first 2 years because of ulcerative colitis-associated causes. The mortality from colorectal cancer was not increased and that of cancer in general was significantly lower than expected: 50 vs. 71 (SMR, 0.70; 95% CI, 0.52–0.93). A significantly increased mortality from pulmonary embolism and pneumonia was found. Among women only, death from genitourinary tract diseases and suicide was significantly increased. Conclusions : Despite an overall normal life expectancy for patients with ulcerative colitis, patients >50 years of age and with extensive colitis at diagnosis had increased mortality within the first 2 years after diagnosis, owing to colitis-associated postoperative complications and comorbidity.

Low mortality in ulcerative colitis and Crohn’s disease in three regional centers in England

OBJECTIVES: Recent epidemiological studies suggest that mortality rates for inflammatory bowel disease (IBD) are similar to those of the general population. However, most of this work has been done in referred populations or larger urban centers. We intended to estimate mortality rates for ulcerative colitis (UC) and Crohn’s disease (CD) in three British district general hospital practices in Wolverhampton, Salisbury, and Swindon. METHODS: Consecutive patients with CD or UC were identified from 1978 to 1986 and followed prospectively. Demographic data, date and cause of death or health status at December 31, 1993 were used to estimate standardized mortality ratios (SMRs) and 95% confidence intervals. RESULTS: Sixty-four deaths occurred in 552 patients (UC 41 of 356; CD 23 of 196). The overall SMRs were 103 [95% confidence interval (CI): 79–140] for UC and 94 (95% CI: 59–140) for CD. The respective SMRs were higher only in the first year after diagnosis at 223 (95% CI: 99–439; p = 0.02) and 229 (74–535; p = 0.056), and even then, most subjects died from non-IBD causes (5 of 13). Nonsurvivors were significantly older than survivors in both UC and CD ( p < 0.01). The SMR was also significantly greater during a severe first attack of UC at 310 (95% CI: 84–793; p = 0.04). Patients with perianal or colonic CD had an increased SMR [396 (95% CI: 108–335; p = 0.02) and 164 (95% CI: 82–335; p = 0.02)] respectively, partly related to the older mean age (52 vs 32 yr, p < 0.001). CONCLUSIONS: Mortality rates are not increased in IBD compared with the general population. However, older patients may be at increased risk of dying from other causes early in the disease clinical course.

Low mortality in ulcerative colitis and Crohn's disease in three regional centers in England.

Recent epidemiological studies suggest that mortality rates for inflammatory bowel disease (IBD) are similar to those of the general population. However, most of this work has been done in referred populations or larger urban centers. We intended to estimate mortality rates for ulcerative colitis (UC) and Crohn's disease (CD) in three British district general hospital practices in Wolverhampton, Salisbury, and Swindon. Consecutive patients with CD or UC were identified from 1978 to 1986 and followed prospectively. Demographic data, date and cause of death or health status at December 31, 1993 were used to estimate standardized mortality ratios (SMRs) and 95% confidence intervals. Sixty-four deaths occurred in 552 patients (UC 41 of 356; CD 23 of 196). The overall SMRs were 103 [95% confidence interval (CI): 79-140] for UC and 94 (95% CI: 59-140) for CD. The respective SMRs were higher only in the first year after diagnosis at 223 (95% CI: 99-439; p = 0.02) and 229 (74-535; p = 0.056), and even then, most subjects died from non-IBD causes (5 of 13). Nonsurvivors were significantly older than survivors in both UC and CD (p < 0.01). The SMR was also significantly greater during a severe first attack of UC at 310 (95% CI: 84-793; p = 0.04). Patients with perianal or colonic CD had an increased SMR [396 (95% CI: 108-335; p = 0.02) and 164 (95% CI: 82-335; p = 0.02)] respectively, partly related to the older mean age (52 vs 32 yr, p < 0.001). Mortality rates are not increased in IBD compared with the general population. However, older patients may be at increased risk of dying from other causes early in the disease clinical course.

Is colonoscopic surveillance reducing colorectal cancer mortality in ulcerative colitis? A population based case control study

Background—Colonoscopic surveillance is a standard procedure in many patients with long standing, extensive ulcerative colitis (UC), in order to avoid death from colorectal cancer. No conclusive proof of its benefits...

Mortality in Ulcerative Colitis: Methods of Analysis

Mortality in Ulcerative Colitis: Methods of Analysis