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Severity of Inflammation as a Predictor of Colectomy in Patients With Chronic Ulcerative Colitis

Hefti, Marco M. B.A.1; Chessin, David B. M.D.1; Harpaz, Noam H. M.D.2; Steinhagen, Randolph M. M.D.1; Ullman, Thomas A. M.D.3

Diseases of the Colon & Rectum: February 2009 - Volume 52 - Issue 2 - p 193-197
doi: 10.1007/DCR.0b013e31819ad456
Original Contributions

PURPOSE: We evaluated a large cohort of patients with longstanding ulcerative colitis in a colonoscopic surveillance program to determine predictors of colectomy.

METHODS: We queried a retrospective database of patients who had symptoms of ulcerative colitis for seven years or more. Histologic inflammation in biopsies was graded on a validated four-point scale: absent, mild, moderate, severe. We performed a multivariate analysis of the inflammation scores and other variables to determine predictive factors for colectomy. Patients who underwent colectomy for neoplasia were censored at the time of surgery; those who did not undergo colectomy were censored at the time of last contact.

RESULTS: A total of 561 patients were evaluated, with a median follow-up of 21.4 years since disease onset. A total of 97 patients (17.3 percent) underwent surgery; 25 (4.5 percent) for reasons other than dysplasia. These 25 constitute events for this analysis. For univariate analysis, mean inflammation (P < 0.001) and steroid use (P = 0.01) were predictors of colectomy. For multivariable proportional hazards analysis, mean inflammation (P < 0.001) and steroid use (P = 0.03) were predictors of colectomy, whereas salicylate use (P = 0.007) was protective.

CONCLUSIONS: Higher median inflammation scores and corticosteroid use were predictors of colectomy in this patient population. The overall rate of colectomy during a long period of follow-up was low (<1 percent per year).

1 Department of Surgery, Mount Sinai School of Medicine, New York, New York

2 Department of Pathology, Mount Sinai School of Medicine, New York, New York

3 Department of Medicine, Mount Sinai School of Medicine, New York, New York

Supported by NIH Grant Number K-08-DK069-393 (to Dr. T. Ullman).

Read at the meeting of The American Society of Colon and Rectal Surgeons, Boston, Massachusetts, June 7 to 11, 2008.

Address of correspondence: Randolph M. Steinhagen, M.D., One Gustave L. Levy Place, New York, New York 10029. E-mail:

© The ASCRS 2009