The long-term outcomes of a cohort of Sri Lankan patients with ulcerative colitis: a retrospective study at two national referral centers and review of literature

Abstract

Sudul Mananjala Senanayake,1 Anthony Nilesh Ranjeev Fernandopulle,2 Madunil Anuk Niriella,1,3 Nethini Thilanga Wijesinghe,3 Amanda Ranaweera,3 Mohammadu Nisar Mufeena,3 Arunasalam Pathmeswaran,4 Nawarathnelage Meththananda Nawarathne,2 Arjuna Priyadarsin de Silva,1,3 Hithanadura Janaka de Silva1,3 1University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka; 2Gastroenterology Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka; 3Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka; 4Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka Background: Inflammatory bowel disease, especially ulcerative colitis, is increasing in many "non-Western" countries, including Sri Lanka. The aim was to evaluate long-term outcomes of ulcerative colitis in a Sri Lankan population. Methods: A retrospective cohort study was conducted at the gastroenterology clinics of the Colombo North Teaching Hospital, Ragama and the National Hospital of Sri Lanka, Colombo; the two major referral centers for ulcerative colitis. All cases had histological confirmation of ulcerative colitis. Three outcomes: colectomy, development of colorectal carcinoma, and death were assessed. Patients not attending the clinic during the previous 4 weeks, or their families, were contacted to obtain clinical details and survival status. In those who had died, the cause of death was confirmed from clinical records and death certificates. Results: Details of 348/425 (81.9%) patients with ulcerative colitis (mean age 45.6 [standard deviation {SD} 14.3] years, male/female ratio = 1.00:1.03) were available. The mean follow-up was 6.8 (SD 6.5) years. The cumulative colectomy rates at 1, 5, 10, and 15 years were 1.5%, 4.0%, 5.5%, and 9.3% respectively. The cumulative probability of colorectal cancer in this cohort after 10 and 15 years was 0.47% and 2.36% respectively. The cumulative survival rate after 1, 5, 10, and 15 years was 99.7%, 98.9%, 98.1%, and 94.5% respectively. Patients with pancolitis were more likely to have disease-related death (P = 0.05). Multivariate analysis (Cox proportional hazards model) showed that an older age at diagnosis was associated with long-term mortality (hazard ratio, 1.11; P = 0.001). Conclusion: In this cohort, colectomy, colorectal carcinoma, and death rates were low, suggesting a relatively benign disease course for ulcerative colitis. Keywords: survival, colectomy, colorectal carcinoma