title: Natural history of severe ulcerative colitis in a community-based health plan.
abstract: OBJECTIVE
  We sought to evaluate long-term outcomes of patients with severe ulcerative colitis (UC) after their first hospitalization for the disease.
  
  
  METHODS
  A cohort of 656 patients hospitalized for UC during 1996 to 2004 was followed up for 9 years through 2004. Time-to-event was estimated using actuarial methods, and the proportions of those under follow-up evaluation who experienced outcomes at month 3, year 1, and year 5 were determined. Outcome measures studied were time to subsequent colectomy, rehospitalization for inflammatory bowel disease, and restarting steroid medication. We also used survival analysis to evaluate whether patient characteristics predicted the risk of rehospitalization and colectomy.
  
  
  RESULTS
  Among 656 patients initially hospitalized for severe UC, 20% (N = 129) underwent colectomy during their initial hospitalization. Of the remaining 527, a total of 95% (N = 498) were discharged on a steroid taper. At 1 year after discharge, 29% of those remaining under observation were rehospitalized for UC, and an additional 10% required colectomy. At 1 and 5 years after discharge, 34% and 26% received at least a 90-day supply of steroid in the preceding 9 months. Risk of rehospitalization and colectomy were unrelated to the patient's age, sex, or race/ethnicity.
  
  
  CONCLUSIONS
  The risk for colectomy in patients hospitalized for the first time with severe UC is 20%. In the 3 months after hospitalization the risk for colectomy is 6%. After that, risks appear to decrease proportionate to the time since initial hospitalization.
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California 94612, USA. jallison@medsfgh.ucsf.edu
authors.forename: James
authors.initials: J
authors.lastname: Allison
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Herrinton
authors.forename: Liyan
authors.initials: L
authors.lastname: Liu
authors.forename: Jenny
authors.initials: J
authors.lastname: Yu
authors.forename: James
authors.initials: J
authors.lastname: Lowder
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000150:complications / Q000188:drug therapy / Q000473:pathology* / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D013256:Steroids / Q000627:therapeutic use; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D013256:Steroids