Korean J Intern Med.  2017 Jan;32(1):69-78. 10.3904/kjim.2014.262.

Comparing the clinical outcomes of young-onset and adult-onset ulcerative colitis: a multi-center Korean Association for the Study for Intestinal Diseases study

• Kim JY
• Park DI
• Han DS
• Huh KC
• Lee CK
• Shin JE
• Kim JH
• Kim YS
• Jung Y
• Jung SA
• Song HJ
• Jang HJ
• Kim YH
• Hong SN

• KMID: 2365980
• DOI: http://doi.org/10.3904/kjim.2014.262

Abstract

BACKGROUND/AIMS
The aim of this study was to compare the clinical features and outcomes of ulcerative colitis (UC) according to the age of onset in Korea.
METHODS
A total of 1,141 patients who were diagnosed with UC between July 1987 and November 2013 at 11 tertiary hospitals were enrolled. The baseline disease characteristic and disease state at onset, treatment during the disease course were retrospectively reviewed among patients with young-onset (YO, < 20 years) and adult-onset (AO, ≥ 20 years). Severe outcome was defined as use of intravenous (IV) steroids, infliximab, immunosuppressant, or UC-related operation.
RESULTS
There were 55 YO patients (mean age, 17.8 ± 2.4) and 1,086 AO patients (mean age, 43.0 ± 13.6). High Mayo scores (7.7 ± 3.0 vs. 5.6 ± 2.7, p = 0.000), extensive UC (52.7% vs. 25.8%, p = 0.000) and IV steroid (41.8% vs. 18.0%, p = 0.000), immunosuppressant (47.3% vs. 26.9%, p = 0.002), and infliximab (20.0% vs. 7.2%, p = 0.001) use were more frequent in the YO than in the AO group. According to multivariate analysis, severe outcomes were related to YO disease (hazard ratio [HR], 2.18; 95% confidence interval [CI], 1.27 to 3.71), body mass index < 23 kg/m² (HR, 1.46; 95% CI, 1.07 to 2.00), severe (HR, 2.29; 95% CI, 1.36 to 3.38), and moderate (HR, 2.48; 95% CI, 1.67 to 3.67) disease, extensive UC (HR, 2.90; 95% CI, 1.79 to 4.69), UC-related admission (HR, 63.89; 95% CI, 20.41 to 200.02), and oral steroid use (HR, 0.51; 95% CI, 0.39 to 0.67).
CONCLUSIONS
UC with YO presented with more advanced clinical features at onset and more severe outcomes than the AO. YO cases require careful management and intense treatment strategies.

Keyword

Colitis, ulcerative; Young-onset; Clinical feature; Outcome

MeSH Terms

Age of Onset
Body Mass Index
Colitis, Ulcerative*
Humans
Infliximab
Intestinal Diseases*
Korea
Multivariate Analysis
Retrospective Studies
Steroids
Tertiary Care Centers
Ulcer*
Infliximab
Steroids