Ulcerative Colitis Is on the Rise

Summary and Comment |
September 1, 2017

Ulcerative Colitis Is on the Rise

  1. Douglas K. Rex, MD

In Sweden, ulcerative colitis incidence has risen fivefold and prevalence tenfold since the mid-1960s.

  1. Douglas K. Rex, MD

Numerous studies document rising incidence rates of inflammatory bowel disease (IBD). A recent population-based study from Sweden illustrates the magnitude of the increase in ulcerative colitis (UC). Data were examined retrospectively but collected prospectively, in a setting with little apparent risk for ascertainment bias, loss of patients to private physicians, or change in the local population with regard to immigration.

During the study period of more than 4 decades (1963–2010), annual incidence rates of UC increased from 4 to 18 per 100,000 and prevalence rates increased from 44 to 474 per 100,000. Disease progression at 10 years after diagnosis was evident in 35% of patients with proctitis at diagnosis compared with 19% of those with left-sided colitis at diagnosis. The risk for colectomy at 10 years postdiagnosis was 39% lower during the latest third of the study period (1991–2005) compared with the earliest third (1963–1975), possibly due to increased use of thiopurines and anti–tumor necrosis factor agents.

Comment

With a fivefold rise in incidence and a tenfold increase in prevalence of UC, as well as a dramatic expansion in the armamentarium and toxicity of therapeutic agents, it's easy to see why IBD management is trending toward its own subspecialty, particularly in academic centers. The causes of increasing UC rates remain uncertain, though the declining rate of cigarette smoking is one clear factor.

Editor Disclosures at Time of Publication

  • Disclosures for Douglas K. Rex, MD at time of publication Consultant/Advisory board Olympus Corporation America; Boston Scientific Speaker’s bureau Boston Scientific Grant/Research support Medtronic; Boston Scientific; Colonary Solutions; Paion Medical; Medivators; Braintree Laboratories Editorial boards World Journal of Gastroenterology; The Journal of Clinical Gastroenterology; Techniques in Gastrointestinal Endoscopy; Gastroenterology & Hepatology; Expert Review of Gastroenterology & Hepatology; Medscape Gastroenterology; World Journal of Gastrointestinal Pharmacology and Therapeutics; Annals of Gastroenterology & Hepatology; World Journal of Gastrointestinal Oncology; Comparative Effectiveness Research; Journal of Anesthesia & Clinical Research; Gastroenterology; World Journal of Gastrointestinal Pathophysiology; Gastroenterology Research and Practice; GI & Hepatology News; Gastroenterology Report; Clinical Epidemiology Reviews; JSM Gastroenterology and Hepatology; GI Journal Watch; Austin Journal of Gastroenterology; World Journal of Gastrointestinal Pharmacology & Therapeutics Leadership positions in professional societies American Society for Gastrointestinal Endoscopy (Councilor); US Multi-Society Task Force (AGA, ACG, ASGE) (Chair)

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