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Factors associated with exacerbation of newly diagnosed mild ulcerative colitis based on a nationwide registry in Japan

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Abstract

Background

The exacerbation of disease in patients with ulcerative colitis (UC) can greatly affect quality of life and can impose economic burdens. In Japan, a large nationwide registry for the medical reimbursement of UC patients has existed since 1975. We aimed to examine factors associated with UC exacerbation among patients newly diagnosed with mild UC using electronic data from the registry.

Methods

We retrospectively reviewed the clinical data of patients (n = 8120) newly diagnosed with mild UC between 2003 and 2011, and examined the association of patient background, medications, clinical symptoms and laboratory data, and pathological findings with exacerbation of UC, using the Cox proportional hazards model.

Results

The incidence of UC exacerbation was 94.6 per 1000 person-years (mean follow-up of 2.1 years). We found that male sex, age <17 years, an extensive lesion (left-sided colitis or pancolitis), overweight or obesity, hematochezia (mild or moderate-to-severe), mushy stools, frequency of bowel movements, and crypt architectural distortion were positively associated with UC exacerbation. On the other hand, age >40 years, high hemoglobin concentration, and high serum albumin levels were inversely associated with UC exacerbation among patients with mild UC in Japan.

Conclusion

Using data from the Japanese nationwide registry, we identified several factors, including body mass index and pathological findings, associated with disease exacerbation among patients with newly diagnosed mild UC. Our findings may lead to earlier recognition of exacerbation in patients with mild UC, thus enabling optimal care.

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Abbreviations

UC:

Ulcerative colitis

MHLW:

Ministry of Health, Labour and Welfare

FH:

Family history

Hb:

Hemoglobin

BMI:

Body mass index

5-ASA:

5-Aminosalicylate

CRP:

C-Reactive protein

TP:

Total protein

Alb:

Serum albumin

ESR:

Erythrocyte sedimentation rate

HR:

Hazard ratio

CI:

Confidence interval

SD:

Standard deviation

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Acknowledgments

The members of this Japanese IBD research group were organized by the Ministry of Health, Labour and Welfare of Japan. This work was supported in part by Health and Labour Sciences Research Grants for research on intractable diseases from the Japanese Ministry of Health, Labour and Welfare. We would like to express our gratitude to a number of physicians and surgeons in Japan who were involved in UC treatment and who prepared the registration forms.

Author information

Authors and Affiliations

  1. Department of Environmental and Occupational Health, School of Medicine, Toho University, 5-21-16 Omori-nishi, Ohta-ku, Tokyo, 143-8540, Japan

    Erika Kuwahara, Takahiro Nakamura & Yuji Nishiwaki

  2. Department of Medical Statistics, School of Medicine, Toho University, Tokyo, Japan

    Yoshitaka Murakami

  3. Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan

    Nagamu Inoue

  4. Advanced Clinical Center for Inflammatory Bowel Disease, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan

    Masakazu Nagahori

  5. Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan

    Toshiyuki Matsui

  6. Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan

    Mamoru Watanabe

  7. Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan

    Yasuo Suzuki

Authors
  1. Erika Kuwahara
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  2. Yoshitaka Murakami
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  3. Takahiro Nakamura
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  4. Nagamu Inoue
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  5. Masakazu Nagahori
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  6. Toshiyuki Matsui
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  7. Mamoru Watanabe
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  8. Yasuo Suzuki
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  9. Yuji Nishiwaki
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Corresponding author

Correspondence to Erika Kuwahara.

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Conflict of interest

YS has received lecture honoraria from Mitsubishi Tanabe Pharma Corporation, ZERIA Pharmaceutical Co., Ltd., and AbbVie GK. TM has received research grants from Eisai Co., Ltd., Mitsubishi Tanabe Pharma Corporation., AJINOMOTO PHARMACEUTICALS Co., Ltd., ZERIA Pharmaceutical Co., Ltd., Kyorin Pharmaceutical Co., Ltd., and JIMRO Co., Ltd., and has received lecture fees from Eisai Co., Ltd. MN has received lecture honoraria from Mitsubishi Tanabe Pharma Corporation, Eisai Co., and AbbVie GK. All remaining authors declare that they have no competing interests.

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Kuwahara, E., Murakami, Y., Nakamura, T. et al. Factors associated with exacerbation of newly diagnosed mild ulcerative colitis based on a nationwide registry in Japan. J Gastroenterol 52, 185–193 (2017). https://doi.org/10.1007/s00535-016-1209-x

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  • DOI: https://doi.org/10.1007/s00535-016-1209-x

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