Kariyawasam, V.C.Middleton, K.L.Lunney, P.C.Wang, R.R.Andrews, J.M.Selinger, C.P.Katelaris, P.Leong, R.W.2022-08-242022-08-242012Journal of Gastroenterology and Hepatology, 2012, vol.27, iss.Suppl. 4, pp.107-1081440-1746https://hdl.handle.net/2440/136152Background: Colectomy in ulcerative colitis (UC) may be indicated at initial diagnosis or during follow-up. The colectomy rate and whether colectomy rate has reduced with modern treatments is currently not well known. Predictors of colectomy may include disease phenotype but may also be influenced by medical treatment. Aims: This study aims to describe the UC cohort of Sydney Local Health District, an extension of the Sydney IBD Cohort. The study describes the cumulative colectomy rates over two time periods: pre- and post-2000. Potential predictive factors of colectomy include its phenotype according to the Montreal Classification and medical treatment. Methods UC patients were recruited. Their medical records were reviewed for demographics, disease characteristics, treatments and surgery. Kaplan Meier analysis illustrates the cumulative probability of colectomy and statistical significance was determined by the log rank test. Predictive factors for colectomy and immunomodulator (IM) use were investigated using multivariate binary logistic regression. Results: In total, 890 patients (52% males) were recruited, with a mean age at diagnosis of 37.4 years (IQR: 24–49). The median follow-up was 14 years (IQR: 5–24) with an overall 14,597 patient-years of follow-up. Ever smokers comprised of 22%. Immunomodulators use was 26%, 5-ASA 90% and long-term steroid use (defined as steroid use >6 months in a year) was 36%. Steroid-use significantly decreased in patients diagnosed post-2000 compared to pre-2000 (P = 0.013). A total of 137 (15.4%) colectomies were performed, most commonly total colectomy (TC) with ileostomy (61%) and TC with pouch anastomosis (23%). The early colectomy rate within the first year of diagnosis was 3.2%. Thereafter, the mean time to colectomy was 11.9 years (IQR: 3–18; Figure 1). The colectomy rate has significantly decreased in the post-2000 UC cohort compared to the pre-2000 UC cohort, whether analysed for all-time colectomies (P = 0.017) or only colectomies after the first year of diagnosis (P = 0.042). Extensive colitis (OR: 1.85, 95% CI: 1.34–2.56, P < 0.0001), steroid dependency (OR: 10.54, 95% CI: 5.36–20.73, P < 0.0001), smoking (OR: 3.03, 95% CI: 1.38–6.67, P < 0.0001) and younger age at diagnosis (OR: 0.96, 95% CI: 0.94–0.98, P < 0.0001) all significantly predicted the need for IM therapy. Extensive colitis (OR: 3.90, 95% CI: 1.61–9.47, P = 0.003) and steroid dependency (OR: 5.285, 95% CI: 2.03–13.78, P = 0.001) were significant predictors for colectomy, but IM did not reduce the colectomy rate. Conclusion This large cohort study showed a significant reduction in the cumulative colectomy rate in ulcerative colitis patients in the recent decade. However, immunomodulator use was not associated with this reduction. Significant predictors of colectomy included extensive colitis and corticosteroid dependency.en© 2012 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty LtdConference item10.1111/j.1440-1746.2011.07251_6.x284880Andrews, J.M. [0000-0001-7960-2650]