Ulcerative Colitis
Ulcerative Colitis
It is critical that physicians know the risk factors for relapse of disease because more effective treatments can be given to patients who are at high risk. In some cases, patients with UC can achieve long-term remission when treated only with 5-ASA. By contrast, some of the UC patients were in the active stage at least yearly for the first 5 years after the onset of disease. Thus, early intervention with immunomodulators and biologics may be needed for patients in this high-risk group. The choice of maintenance treatment in UC is determined by disease extent, disease course, failure of previous maintenance treatment, the severity of the most recent flare, the safety of the maintenance treatment and also cancer prevention. A number of previous studies regarding risk factors for relapse showed that a short duration of current remission, more frequent relapses, extraintestinal manifestations and younger age were predictors of relapse. Extensive colitis was associated with an increased risk of colectomy, and can also be considered as a risk factor of worse outcome. Serological and pathological markers have also been evaluated. A higher erythrocyte sedimentation rate and basal plasmacytosis on rectal mucosa were associated with an increased risk of relapse or colectomy. Perinuclear anti-neutrophil cytoplasmic antibodies are associated with the risk of subsequent chronic pouchitis in UC patients after colectomy. A summary of risk factors for relapse is shown in Box 1. Although immunomodulators and biologics are useful for patients with refractory UC, their effectiveness among patients who are at high risk for relapse remains unclear.
Risk Assessments for Relapse
It is critical that physicians know the risk factors for relapse of disease because more effective treatments can be given to patients who are at high risk. In some cases, patients with UC can achieve long-term remission when treated only with 5-ASA. By contrast, some of the UC patients were in the active stage at least yearly for the first 5 years after the onset of disease. Thus, early intervention with immunomodulators and biologics may be needed for patients in this high-risk group. The choice of maintenance treatment in UC is determined by disease extent, disease course, failure of previous maintenance treatment, the severity of the most recent flare, the safety of the maintenance treatment and also cancer prevention. A number of previous studies regarding risk factors for relapse showed that a short duration of current remission, more frequent relapses, extraintestinal manifestations and younger age were predictors of relapse. Extensive colitis was associated with an increased risk of colectomy, and can also be considered as a risk factor of worse outcome. Serological and pathological markers have also been evaluated. A higher erythrocyte sedimentation rate and basal plasmacytosis on rectal mucosa were associated with an increased risk of relapse or colectomy. Perinuclear anti-neutrophil cytoplasmic antibodies are associated with the risk of subsequent chronic pouchitis in UC patients after colectomy. A summary of risk factors for relapse is shown in Box 1. Although immunomodulators and biologics are useful for patients with refractory UC, their effectiveness among patients who are at high risk for relapse remains unclear.
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