Ulcerative colitis in a Southern European country: a national perspective.
BACKGROUND
The incidence, prevalence, and even the clinical behavior of ulcerative colitis (UC) are highly variable in different world regions. In previous studies, Portugal was reported as having a milder clinical behavior. The aim of this study was to apply the Montreal Classification in a large group of UC Portuguese patients in order to describe their clinical characteristics and evaluate variables potentially useful for outcome prediction.


METHODS
A cross-sectional study based on data collected from a nationwide online registry was undertaken.


RESULTS
In all, 2863 patients with UC were included. Twenty-one percent had ulcerative proctitis, 52% left-sided colitis, and 28% extensive colitis. Sixty percent of patients had taken steroids, 14% immunosuppressors, 1% biologicals, and 4.5% were submitted to surgery. Patients with extensive colitis had more severe activity, needing more steroids, immunosuppressors, and surgery. At the time of diagnosis 61% were less than 40 years old and 5% less than 16. Younger patients also had a more aggressive initial course. Thirty-eight percent of patients had only taken salicylates during the disease course and were characterized by a lower incidence of systemic symptoms at presentation (3.8% versus 8.8%, P < 0.001), fewer extraintestinal manifestations (7.7% versus 24.0%, P < 0.001), and a higher prevalence of proctitis (32.1% versus 10.0%).


CONCLUSIONS
A more aggressive phenotype was found in extensive colitis and in the initial course of younger patients, with an increased need for steroids and immunosuppressors. In addition, a significant percentage of patients, particularly with proctitis, showed a milder clinical evolution and were maintained in remission only with salicylates.
Portela
Francisco
F
Portuguese Study Group of Inflammatory Bowel Diseases (GEDII), Hospitais da Universidade de Coimbra, Portugal. fasportela@gmail.com
Magro
Fernando
F
Lago
Paula
P
Cotter
José
J
Cremers
Isabelle
I
de Deus
João
J
Vieira
Ana
A
Lopes
Horácio
H
Caldeira
Paulo
P
Barros
Luísa
L
Reis
Jorge
J
Carvalho
Laura
L
Gonçalves
Raquel
R
Campos
Mário J
MJ
Ministro
Paula
P
Duarte
Maria A
MA
Amil
Jorge
J
Rodrigues
Susana
S
Azevedo
Luís
L
Costa-Pereira
A
A
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011174:Portugal / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D055815:Young Adult