Ulcerative Colitis: Colectomy Risk Dips in the 21st Century
The risk for colectomy declined over the past two decades among Finnish patients with newly diagnosed ulcerative colitis (UC), particularly between 2013 and 2020, when several advanced treatment options were available.
METHODOLOGY
Researchers in Finland utilized data from a population-based registry between January 2000 and December 2020 to determine the risk for colectomy in patients with newly diagnosed UC and compare risks across different eras.
They identified 32,108 patients, of whom 2195 underwent colectomy (median age at surgery, 39.4 years; 60.5% men); patients were stratified into three groups — 2000-2005 (prebiological era), 2006-2012, and 2013-2020 — according to the time of diagnosis and the availability of treatments.
Participants were also stratified by age at diagnosis into paediatric (< 20 years), adult (20-59 years), and older adult (≥ 60 years) groups.
TAKEAWAY:
The cumulative risk for colectomy was 1.0% at 1 year, 4.7% at 5 years, and 7.3% at 10 years following UC diagnosis.
Compared with the prebiological era, the 2013-2020 era saw a reduction in the 1-year and 5-year risks for colectomy (incidence rate ratio [IRR], 0.757 and 0.70, respectively), and the 2006-2012 era saw a reduction in the 10-year risk (IRR, 0.87).
The paediatric population experienced a lower risk for surgery in the 2013-2020 era than in previous eras, whereas the risk for surgery among older adult patients remained unchanged from earlier periods.
Compared with the adult population, the paediatric population faced a higher risk for surgery (IRR, 1.69), whereas the older adult population had a lower risk (IRR, 0.79).
IN PRACTICE:
"The risk of colectomy among Finnish UC patients has decreased in the 21st century. The risk reduction coincides with the use of advanced medical therapy and more ambitious treatment targets, and it can also be seen in children and adolescents. The elderly have lower colectomy rates than do younger newly diagnosed patients, but their risk has remained constant," the authors wrote.
SOURCE:
This study was led by Kristi Kontola, Department of Internal Medicine, Wellbeing Services County of South Ostrobothnia, Seinäjoki, Finland. It was published online on May 13, 2025, in the Journal of Crohn's and Colitis .
LIMITATIONS:
This study was limited by the lack of follow-up data and the use of non-inflammatory bowel disease registries. The Social Insurance Institution registry was not updated with clinical data after initial reimbursement approval; hence, it may have included misdiagnosed cases. Additionally, the national registries used in this study did not contain detailed clinical information, preventing the analysis of important parameters such as disease extent and specific indications for colectomy.
DISCLOSURES:
This study was supported by the Wellbeing Services County of South Ostrobothnia and the Mary and Georg C. Ehrnrooth Foundation. One author reported being a national representative of ECCO, a board member of the Finnish Society of Gastroenterology, and a member of the scientific advisory board of the Finnish Coeliac Society. Another author reported being a board member of the IBD subdivision of the Finnish Society of Gastroenterology and a consultant for the Nursing Research Foundation. Some also reported receiving personal fees from various pharmaceutical companies.
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