Digestive Diseases and Sciences

, Volume 38, Issue 6, pp 1137–1146 | Cite as

Clinical patterns, natural history, and progression of ulcerative colitis

A long-term follow-up of 1116 patients
  • Richard G. Farmer
  • Kirk A. Easley
  • George B. Rankin
Original Articles


We studied the natural history of ulcerative colitis (UC) by following 1116 patients in whom UC had been diagnosed or confirmed at The Cleveland Clinic Foundation between 1960 and 1983. Data before 1973 were obtained retrospectively. Criteria for inclusion in the study were: a diagnosis of UC confirmed by clinical, radiographic, endoscopic, and histologic examination; disease location that could be defined as one of three categories (proctosigmoiditis, pancolitis, or left-sided colitis); and a follow-up of at least five years (mean=12.7 years). Mean age at diagnosis was 32 years. Of the 1116 patients, 46.2% (516) had proctosigmoiditis; 36.7% (410) had pancolitis (colitis of the entire large intestine); and 17.0% (190) had left-sided colitis (from the dentate line to the splenic flexure). Early complications (within two years of diagnosis) included colonic hemorrhage (16.7%) and toxic colitis (12.7%). Complications were highest among patients with pancolitis. Surgery was required for 37.6% of the patients. Primary indications for surgery included chronic or intractable disability (40.2%), fulminating medical failure (16.9%), and colonic dilatation (18.4%). At the most recent follow-up, the disease had extended (progressed to a more serious category) in 53.8% of the patients, although 67.2% were asymptomatic and only 37.0% were on medications. Both the final disease destination and the initial diagnosis impacted cumulative colectomy-ileostomy rates. Factors associated with extension were toxic colitis (P<0.0001); extent of disease at diagnosis (P<0.0001); joint symptoms (P=0.0008); younger age at diagnosis (P=0.06); and severe bleeding (P=0.07).

Key Words

ulcerative colitis inflammatory bowel disease risk factors natural history progression 


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  1. 1.
    Sloan WP, Bargen JA, Gage RP: Life histories of patients with chronic ulcerative colitis: A review of 2,000 cases. Gastroenterology 16:25–38, 1950Google Scholar
  2. 2.
    Farmer RG, Whelan G, Fazio VW: Long-term follow-up of patients with Crohn's disease. Gastroenterology 88:1825–1833, 1985Google Scholar
  3. 3.
    Softley A, Clamp SE, Watkinson G, et al: The natural history of inflammatory bowel disease: Has there been any change in the last 20 years? Scand J Gastroenterol 23(S144):20–23, 1988Google Scholar
  4. 4.
    Riddell RH, Goldman H, Ransohoff DF, et al: Dysplasia in inflammatory bowel disease: Standardized classification with provisional clinical applications. Hum Pathol 14:931–968, 1983Google Scholar
  5. 5.
    Mir-Madjlessi SH, Farmer RG, Easley KA, Beck GJ: Colorectal and extracolonic malignancy in ulcerative colitis. Cancer 58:1569–1574, 1986Google Scholar
  6. 6.
    Gyde S, Prior P, Dew MJ, et al: Mortality in ulcerative colitis. Gastroenterology 83:36–43, 1982Google Scholar
  7. 7.
    Rosenstock E, Farmer RG, Petras R, et al: Surveillance for colonic carcinoma in ulcerative colitis. Gastroenterology 89:1342–1346, 1985Google Scholar
  8. 8.
    SAS Institute Inc., SAS/STAT Users Guide, Version 6, 4th ed., Vol. 2. Cary, North Carolina, SAS Institute Inc., 1989, 846 ppGoogle Scholar
  9. 9.
    Engleman L: BMDP LR: Stepwise logistic regression.In BMDP Statistical Software, Vol 2. JW Dixon (ed). Berkeley, University of California Press, 1988, p 941Google Scholar
  10. 10.
    Fazio VW: Toxic megacolon in ulcerative colitis and Crohn's colitis. Clin Gastroenterol 2:389–407, 1980Google Scholar
  11. 11.
    Farmer RG, Michener WM, Mortimer EA: Long-term prognosis of ulcerative colitis with onset in childhood or adolescence. J Clin Gastroenterol 1:301–305, 1979Google Scholar
  12. 12.
    Edwards FC, Truelove SC: The course and prognosis of ulcerative colitis. Part I and II: Short-term and long-term prognosis. Gut 4:299–315, 1963Google Scholar
  13. 13.
    Watts JM, de Dombal FT, Watkinson G, et al: Long-term prognosis of ulcerative colitis. Br Med J 1:1447–1453, 1966Google Scholar
  14. 14.
    Jalan KN, Prescott RJ, Sircus W, et al: An experience of ulcerative colitis: III. Long-term outcome. Gastroenterology 59:598–609, 1970Google Scholar
  15. 15.
    Bonnevie O, Binder V, Anthonisen P, Riis P: The prognosis of ulcerative colitis. Scand J Gastroenterol 9:81–91, 1974Google Scholar
  16. 16.
    Ritchie JK, Powell-Tuck J, Lennard-Jones JE: Clinical outcome of the first ten years of ulcerative colitis and proctitis. Lancet 1:1140–1143, 1978Google Scholar
  17. 17.
    Stonnington CM, Phillips SF, Zinsmeister AR, Melton LJ III: Prognosis of chronic ulcerative colitis in a community. Gut 28:1261–1266, 1987Google Scholar
  18. 18.
    Hendricksen C, Kreiner S, Binder V: Long-term prognosis in ulcerative colitis—based on results from a regional patient group from the county of Copenhagen. Gut 26:158–163, 1985Google Scholar
  19. 19.
    Brostrom O, Monsen U, Nordenvall B, Sorstad J, Hellers G: Prognosis and mortality of ulcerative colitis in Stockholm county 1955–1979. Scand J Gastroenterol 22:907–913, 1987Google Scholar
  20. 20.
    Leijonmarck CE, Persson PG, Hellers G: Factors affecting colectomy rate in ulcerative colitis: An epidemiologic study. Gut 31:329–333, 1990Google Scholar
  21. 21.
    Sackett DL: Bias in analytic research. J Chron Dis 32:51–63, 1979Google Scholar
  22. 22.
    Green SB, Byar DP: Using observational data from registries to compare treatments: The fallacy of omnimetries. Stat Med 3:361–370, 1984Google Scholar
  23. 23.
    Farmer RG, Brown CH: Ulcerative proctitis: Course and prognosis. Gastroenterology 51:219–223, 1966Google Scholar
  24. 24.
    Farmer RG: Evolution of the concept of proctosigmoiditis: clinical observation. Med Clin North Amer 74:91–102, 1990Google Scholar
  25. 25.
    Ekbom A, Helmick G, Zack M, Adami H: The epidemiology of inflammatory bowel disease: A large, population-based study in Sweden. 100:350–358, 1991Google Scholar
  26. 26.
    Nordenvall B, Brostrom O, Berglund M, et al: Incidence of ulcerative colitis in Stockholm county 1955–1979. Scand J Gastroenterol 20:783–790, 1985Google Scholar
  27. 27.
    Podolsky DK: Inflammatory bowel disease (first of two parts). N Engl J Med 325:928–935, 1991Google Scholar

Copyright information

© Plenum Publishing Corporation 1993

Authors and Affiliations

  • Richard G. Farmer
    • 1
    • 2
    • 3
  • Kirk A. Easley
    • 1
    • 2
    • 3
  • George B. Rankin
    • 1
    • 2
    • 3
  1. 1.Department of Colorectal SurgeryCleveland Clinic FoundationCleveland
  2. 2.Department of Biostatistics and EpidemiologyCleveland Clinic FoundationCleveland
  3. 3.Department of GastroenterologyCleveland Clinic FoundationCleveland
  4. 4.Department of Gastroenterology, Division of MedicineGeorgetown University Medical CenterWashington, DC

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