title: Ulcerative colitis in a Southern European country: a national perspective.
abstract: 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.
authors.affiliation: Portuguese Study Group of Inflammatory Bowel Diseases (GEDII), Hospitais da Universidade de Coimbra, Portugal. fasportela@gmail.com
authors.forename: Francisco
authors.initials: F
authors.lastname: Portela
authors.forename: Fernando
authors.initials: F
authors.lastname: Magro
authors.forename: Paula
authors.initials: P
authors.lastname: Lago
authors.forename: José
authors.initials: J
authors.lastname: Cotter
authors.forename: Isabelle
authors.initials: I
authors.lastname: Cremers
authors.forename: João
authors.initials: J
authors.lastname: de Deus
authors.forename: Ana
authors.initials: A
authors.lastname: Vieira
authors.forename: Horácio
authors.initials: H
authors.lastname: Lopes
authors.forename: Paulo
authors.initials: P
authors.lastname: Caldeira
authors.forename: Luísa
authors.initials: L
authors.lastname: Barros
authors.forename: Jorge
authors.initials: J
authors.lastname: Reis
authors.forename: Laura
authors.initials: L
authors.lastname: Carvalho
authors.forename: Raquel
authors.initials: R
authors.lastname: Gonçalves
authors.forename: Mário J
authors.initials: MJ
authors.lastname: Campos
authors.forename: Paula
authors.initials: P
authors.lastname: Ministro
authors.forename: Maria A
authors.initials: MA
authors.lastname: Duarte
authors.forename: Jorge
authors.initials: J
authors.lastname: Amil
authors.forename: Susana
authors.initials: S
authors.lastname: Rodrigues
authors.forename: Luís
authors.initials: L
authors.lastname: Azevedo
authors.forename: A
authors.initials: A
authors.lastname: Costa-Pereira
mesh_terms: 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