ASSOCIATED FACTORS AND CLINICAL ASPECTS OF COLECTOMY IN PATIENTS WITH ULCERATIVE COLITIS - EXPERIENCE OF A BRAZILIAN SOUTHEASTERN COHORT.

BACKGROUND

Despite recent advances in the medical treatment of ulcerative colitis (UC) involving the use of biological agents and small molecules, a proportion of patients with UC still require surgical treatment.

OBJECTIVE

This study evaluated patient characteristics and factors associated with colectomy in patients with UC at a tertiary IBD center.

METHODS

This is a retrospective and observational study utilizing the database at our university hospital. The sample comprised 232 patients diagnosed with UC, with a mean age of 46.45±15.00 years, 60.3% of whom were women. The patients were divided into two groups depending on whether or not they had undergone colectomy between January 2001 and December 2018.

RESULTS

Of all 50 (21.6%) patients underwent colectomy. Clinical intractability (40.0%) and acute severe colitis (22%) were the main indications for colectomy. Longer disease duration (P=0.035), pancolitis (82.0% vs 6.0%; P<0.001) when compared to proctitis, higher endoscopic Mayo sub-score (Mayo 3: 22.0% vs Mayo 1: 5.5%; P<0.0001), and initial use of biological agents (14.0% vs 1.1%; P<0.001) were significantly associated with the occurrence of colectomy. There was no difference in the distribution of cases according to sex, race, smoking, previous use of corticosteroids, and extraintestinal manifestations (P>0.05).

CONCLUSION

Our study shows that a longer disease duration, extensive disease (pancolitis), and higher severity of UC at diagnosis were associated with a poor prognosis, culminating in a higher need for surgical intervention.