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COLECTOMY RATE FOR ULCERATIVE COLITIS IN SOUTHWESTERN ONTARIO
L Roth, N Chande, A Lau, M Roth, T Ponich, J Gregor
Division of Gastroenterology, London Health Sciences Centre, London, Ontario
Colectomy is usually considered the last line of treatment for patients with ulcerative colitis (UC). Colectomy rates may help gauge the success of treatment for UC, and highlight possible areas for improvement. We sought to compare colectomy rates in our tertiary care practice in Southwestern Ontario with other published cohorts of UC patients.
METHODS: A retrospective cohort of UC patients followed in the London Health Sciences Centre Inflammatory Bowel Disease (IBD) clinic was reviewed. These patients were further screened to include those with information on disease presentation as well as at least 5 years of follow up. Demographic information, colectomy rates and outcomes were collected.
RESULTS: 102 patients met the inclusion criteria. Fifteen of 102 (14.7%) patients in the cohort underwent colectomy. Of these, 53% were male, 33% had a first degree relative with IBD, 66% were non-smokers and 13% were ex-smokers. Disease severity at presentation was assessed as severe in 6/15 patients (40%), moderate in 6/15 patients (40%), and mild in 3/15 patients (20%). Five patients (33%) also had arthropathy as an extra-intestinal manifestation of their disease, and none had primary sclerosing cholangitis. One patient died during the course of follow up. Disease extent in this cohort was documented as pancolitis in 10/15 patients (66%), left-sided colitis in 1/15 patients (7%) and sigmoiditis in 4/15 patients (27%). The indication for colectomy was poor response to maximal therapy in 10/15 patients (66%), intolerance to medical therapy in 3/15 patients (20%), rectal cancer in 1/15 patients (7%), and perforated rectum in 1/15 patients (7%). Of these, 7 patients underwent an ileal pouch-anal anastomosis with 5 patients (71%) having at least one subsequent episode of pouchitis.
CONCLUSIONS: Colectomy rates in Southwestern Ontario in a cohort of UC patients with at least 5 years of follow up were higher than other published rates. This may reflect the small sample size and selection bias as a tertiary referral centre. Further studies to investigate colectomy rate as an important outcome for UC patients are warranted, particularly as new therapeutic options are becoming available.