Temporal Trends in Medical and Surgical Management of Ulcerative Colitis in England: 2003–2020

作者：Jennifer Couch, Kim S Thomas, Tim Card, David J. Humes · 发表于：Alimentary Pharmacology & Therapeutics · 年份：2025 · DOI：10.1111/apt.70319 · 被引用次数：5 · 研究领域：Inflammatory Bowel Disease、Microscopic Colitis、Enhanced Recovery After Surgery

BACKGROUND: The medical management of ulcerative colitis (UC) is evolving. However, colectomy may be required in severe or refractory cases. AIM: To provide contemporary evidence on medication usage and surgery for UC. METHODS: An incident cohort of patients newly diagnosed with UC from 2003 to 2020 was identified using computerised health records. The cumulative incidence of colectomy and medication use was calculated using Kaplan-Meier methods and compared across 3 time periods. We calculated 90-day post-operative mortality using life tables. Cox regression was used to model the risks of surgery and mortality, adjusting for confounders. RESULTS: 33,464 subjects had an incident diagnosis of UC. 5- year cumulative incidence of elective colectomy reduced from 2.97% to 1.59%, and emergency colectomy from 3.90% to 2.67% from 2003-2007 to 2015-2020. For elective surgery, adjusted hazard ratio (aHR) 0.47 and for emergency surgery, aHR 0.60 when 2015-2020 was compared to 2003-2007. Colectomy was less likely in women (elective aHR 0.73, emergency aHR 0.71) and emergency colectomy was less likely in those aged 40-59, aHR 0.87 than in those aged 18-39. Ninety- day mortality for elective and emergency surgery was 1.47% and 3.81%, respectively. Use of advanced therapies increased from 2.53% to 16.71% at 5 years from diagnosis when comparing 2003-2007 and 2015-2020. CONCLUSION: Colectomy in the five years following diagnosis has declined, coinciding with an increased use of advanced ther...