Ulcerative colitis: relapse was common in definite or indeterminate disease.

Clinical bottom line (level 2b)

  1. Three-quarters of patients with definite ulcerative colitis had a relapse in the following seven years.
  2. About a fifth of patients with probable ulcerative colitis had a relapse in this time.
Stewenius et al: Diseases of the Colon and Rectum 1996; 39: 1019-1025
Expires May 2003

The study

Retrospective cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: university hospital, Sweden, 1958-1982

571 patients (aged range 4 to 88 years; mean 37, 57% male)
  • 354 patients (59% male; aged 6 to 87, mean 37) with definite ulcerative colitis (history of diarrhoea of rectal bleeding for 6 weeks or more with characteristic signs of inflammation on sigmoidoscopy, barium enema, surgical specimen or autopsy)
  • 117 patients (52% male; aged 4 to 88, mean 42) with probable ulcerative colitis (as above, but history or diagnostic findings inadequate)
  • 100 patients (49% male; aged 5 to 77, mean 33) with indeterminate colitis (inflammatory bowel disease but insufficient evidence to indicate UC or Crohn's)


Excluded if
  • initially diagnosed with definite/probable UC and subsequently found to be indeterminate or Crohn's



    • Factors studied:
  • probable ulcerative colitis compared with definite ulcerative colitis
  • indeterminate




    • Multivariate analysis was performed to adjust for confounding factors.

    98% followed for 0 to 30 years (mean 7 years)
    Outcomes studied:
  • definite ulcerative colitis: relapsed
  • probable ulcerative colitis: relapsed
  • indeterminate: relapsed
  • total relapsed

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    definite ulcerative colitis: relapsed 0 to 30 years (mean 7 years) 249/332 75%
    (70% to 80%)
    probable ulcerative colitis: relapsed 0 to 30 years (mean 7 years) 23/110 21%
    (13% to 29%)
    indeterminate: relapsed 0 to 30 years (mean 7 years) 66/80 83%
    (74% to 91%)
    total relapsed 0 to 30 years (mean 7 years) 338/552 61%
    (57% to 65%)

    prognostic factor for
    total relapsed     		time to outcome unadjusted RR
    (95% CI)    		 NNF+
    (95% CI)
    probable ulcerative colitis 0 to 30 years (mean 7 years) 0.3
    (0.2 to 0.4)     		-2
    (-3 to -2)
    indeterminate 0 to 30 years (mean 7 years) 1.9
    (1.6 to 2.4)     		1
    (1 to 2)

    • No other features predicted relapse.

    Citation

    1. Stewenius J, et al: Risk of relapse in new cases of ulcerative colitis and indeterminate colitis. Diseases of the Colon and Rectum 1996; 39: 1019-1025
    Contributor: David Ford and Chris Ball, September 2000
    Reviewer:

    Clinical Question.
    Patient ulcerative colitis
    Intervention or Exposure prevalence
    Outcome relapse