title: Low colectomy rates in ulcerative colitis in an unselected European cohort followed for 10 years.
abstract: OBJECTIVE
  The colectomy rate in ulcerative colitis (UC) is related to morbidity and to treatment decisions made during disease course. The aims of this study were to determine the colectomy risk in UC in the first decade after diagnosis and to identify factors that may influence the choice of surgical treatment.
  
  
  METHODS
  In 1991-1993, 781 UC patients from 9 centers located in 7 countries in northern and southern Europe and in Israel were included in a prospective inception cohort study. After 10 years of follow-up, 617 patients had complete medical records, 73 had died, and 91 had been lost to follow-up.
  
  
  RESULTS
  There were no significant differences in age, sex, or disease extent at diagnosis between patients followed for 10 years and those lost to follow-up. The 10-year cumulative risk of colectomy was 8.7%: 10.4% in the northern and 3.9% in the southern European centers (P < .001). Colectomy was more likely in extensive colitis than in proctitis, with an adjusted hazard ratio (HR) of 4.1 (95% CI: 2.0-8.4). Compared with the southern centers, the adjusted HR was 2.7 (95% CI: 1.3-5.6) for The Netherlands and Norway together and 8.2 (95% CI: 3.6-18.6) for Denmark. Age at diagnosis, sex, and smoking status at diagnosis had no statistically significant influence on colectomy rates.
  
  
  CONCLUSIONS
  The colectomy rate was found to be lower than that in previous publications, but there was a difference between northern and southern Europe. Colectomy was associated with extensive colitis, but the geographic variations could not be explained.
authors.affiliation: Sorlandet Hospital Arendal, Department of Medicine, Section for Gastroenterology, Arendal, Norway. olehoeie@online.no
authors.forename: Ole
authors.initials: O
authors.lastname: Hoie
authors.forename: Frank L
authors.initials: FL
authors.lastname: Wolters
authors.forename: Lene
authors.initials: L
authors.lastname: Riis
authors.forename: Tomm
authors.initials: T
authors.lastname: Bernklev
authors.forename: Geir
authors.initials: G
authors.lastname: Aamodt
authors.forename: Juan
authors.initials: J
authors.lastname: Clofent
authors.forename: Epaminondas
authors.initials: E
authors.lastname: Tsianos
authors.forename: Marina
authors.initials: M
authors.lastname: Beltrami
authors.forename: Selwyn
authors.initials: S
authors.lastname: Odes
authors.forename: Pia
authors.initials: P
authors.lastname: Munkholm
authors.forename: Morten
authors.initials: M
authors.lastname: Vatn
authors.forename: Reinhold W
authors.initials: RW
authors.lastname: Stockbrügger
authors.forename: Bjorn
authors.initials: B
authors.lastname: Moum
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods / Q000706:statistics & numerical data*; D003093:Colitis, Ulcerative / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D064420:Drug-Related Side Effects and Adverse Reactions; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects; D013997:Time Factors