Digestive Diseases and Sciences

, Volume 63, Issue 11, pp 3097–3104 | Cite as

Extensive Disease Subtypes in Adult Patients with Ulcerative Colitis: Non-pancolitis Versus Pancolitis

  • Dong Suk Shin
  • Jae Hee CheonEmail author
  • Yong Eun Park
  • Yehyun Park
  • Soo Jung Park
  • Tae Il Kim
  • Won Ho Kim
Original Article


Background and Aim

Few studies have compared pancolitis and non-pancolitis E3 in adult patients with ulcerative colitis (UC). This study aimed to evaluate the natural disease courses and factors affecting outcomes between pancolitis and non-pancolitis E3.


We retrospectively analyzed 117 patients, including 93 with extensive colitis (E3) and 24 with UC confined to the rectum or left-sided colon and appendiceal orifice inflammation at the time of diagnosis, who were regularly followed up for at least 1 year. Patients with E3 were divided into two groups according to the degree of disease extension: pancolitis group (disease extent up to the cecum or proximal ascending colon) and non-pancolitis E3 group (disease extent above the splenic flexure but not up to the proximal ascending colon). Clinical findings at diagnosis; comorbidity; medications; Mayo score; cumulative rates of corticosteroid, immunomodulator, and anti-tumor necrosis factor (anti-TNF) alpha use; relapse; and admission were compared between the pancolitis and non-pancolitis E3 groups.


The median follow-up duration of the 117 patients was 74 (range 15–158) months. Fifty-one patients (43.5%) had pancolitis. The Mayo score at initial diagnosis, cumulative relapse rate, and cumulative admission rate were significantly higher in the pancolitis group than in the non-pancolitis E3 group (P < 0.001, P = 0.023 and P = 0.007, respectively). However, there was no significant difference between the groups in the rates of cumulative immunomodulator and anti-TNF alpha use (P = 0.67 and P = 0.73, respectively).


In patients with extensive UC (E3), pancolitis was associated with higher probabilities of cumulative relapse or admission, indicating poor prognosis.


Ulcerative colitis Disease extension Prognosis Classification 



Funding was provided by Ministry of Health and Welfare (Grant No. HI14C1324) and Ministry of Science, ICT and Future Planning (Grant No. NRF-2017R1A2B4001848).

Author’s contribution

Dong Suk Shin was involved in acquisition of data, analysis and interpretation of data, and drafting of the manuscript. Yong Eun Park, Yehyun Park, Soo Jung Park, Tae Il Kim, and Won Ho Kim were responsible for the study concept and design and for critical revision of the manuscript for important intellectual content. Jae Hee Cheon was involved in acquisition of data, study concept and design, and critical revision of the manuscript for important intellectual content. All authors approved the final version of the article, including the authorship list.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Supplementary material

10620_2018_5218_MOESM1_ESM.tif (1.1 mb)
Supplementary material 1 (TIFF 1136 kb)
10620_2018_5218_MOESM2_ESM.tif (1 mb)
Supplementary material 2 (TIFF 1065 kb)


  1. 1.
    Danese S, Fiocchi C. Ulcerative colitis. N Engl J Med. 2011;365:1713–1725.CrossRefGoogle Scholar
  2. 2.
    Bernstein CN, Ng SC, Lakatos PL, et al. A review of mortality and surgery in ulcerative colitis: milestones of the seriousness of the disease. Inflamm Bowel Dis. 2013;19:2001–2201.PubMedGoogle Scholar
  3. 3.
    Kim B, Park SJ, Hong SP, et al. Proximal disease extension and related predicting factors in ulcerative proctitis. Scand J Gastroenterol. 2014;49:177–183.CrossRefGoogle Scholar
  4. 4.
    Zhang CK, Hewett J, Hemming J, et al. The influence of depression on quality of life in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2013;19:1732–1739.CrossRefGoogle Scholar
  5. 5.
    Podolsky DK. Inflammatory bowel disease. N Engl J Med. 2002;347:417–429.CrossRefGoogle Scholar
  6. 6.
    Satsangi J, Silverberg MS, Vermeire S, et al. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut. 2006;55:749–753.CrossRefGoogle Scholar
  7. 7.
    Lutgens MW, van Oijen MG, van der Heijden GJ, et al. Declining risk of colorectal cancer in inflammatory bowel disease: an updated meta-analysis of population-based cohort studies. Inflamm Bowel Dis. 2013;19:789–799.CrossRefGoogle Scholar
  8. 8.
    Katz J. The course of inflammatory bowel disease. Med Clin N Am. 1994;78:1275–1280.CrossRefGoogle Scholar
  9. 9.
    Sahami S, Konte K, Buskens CJ, et al. Risk factors for proximal disease extension and colectomy in left-sided ulcerative colitis. United Eur Gastroenterol J. 2017;5:554–562.CrossRefGoogle Scholar
  10. 10.
    Eszter Muller K, Laszlo Lakatos P, Papp M, et al. Incidence and paris classification of pediatric inflammatory bowel disease. Gastroenterol Res Pract. 2014;2014:904307.CrossRefGoogle Scholar
  11. 11.
    Muller KE, Lakatos PL, Arato A, et al. Incidence, Paris classification, and follow-up in a nationwide incident cohort of pediatric patients with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2013;57:576–582.CrossRefGoogle Scholar
  12. 12.
    Reddy D, Murphy SJ, Kane SV, et al. Relapses of inflammatory bowel disease during pregnancy: in-hospital management and birth outcomes. Am J Gastroenterol. 2008;103:1203–1209.CrossRefGoogle Scholar
  13. 13.
    Schroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study. N Engl J Med. 1987;317:1625–1629.CrossRefGoogle Scholar
  14. 14.
    Rutgeerts P, Sandborn WJ, Feagan BG, et al. Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2005;353:2462–2476.CrossRefGoogle Scholar
  15. 15.
    Turner D, Seow CH, Greenberg GR, et al. A systematic prospective comparison of noninvasive disease activity indices in ulcerative colitis. Clin Gastroenterol Hepatol. 2009;7:1081–1088.CrossRefGoogle Scholar
  16. 16.
    Lewis JD, Chuai S, Nessel L, et al. Use of the noninvasive components of the Mayo score to assess clinical response in ulcerative colitis. Inflamm Bowel Dis. 2008;14:1660–1666.CrossRefGoogle Scholar
  17. 17.
    O’Morain C, Tobin A, Leen E, et al. Criteria of case definition in Crohn’s disease and ulcerative colitis. Scand J Gastroenterol Suppl. 1989;170:7–11. discussion 16–19.CrossRefGoogle Scholar
  18. 18.
    Rodgers AD, Cummins AG. CRP correlates with clinical score in ulcerative colitis but not in Crohn’s disease. Dig Dis Sci. 2007;52:2063–2068. CrossRefPubMedGoogle Scholar
  19. 19.
    Prantera C, Davoli M, Lorenzetti R, et al. Clinical and laboratory indicators of extent of ulcerative colitis. Serum C-reactive protein helps the most. J Clin Gastroenterol. 1988;10:41–45.CrossRefGoogle Scholar
  20. 20.
    Lee JH, Cheon JH, Kim ES, et al. The prevalence and clinical significance of perinuclear anti-neutrophil cytoplasmic antibody in Korean patients with ulcerative colitis. Dig Dis Sci. 2010;55:1406–1412. CrossRefPubMedGoogle Scholar
  21. 21.
    Park SH, Loftus EV Jr, Yang SK. Appendiceal skip inflammation and ulcerative colitis. Dig Dis Sci. 2014;59:2050–2057. CrossRefPubMedGoogle Scholar
  22. 22.
    Solberg IC, Lygren I, Jahnsen J, et al. Clinical course during the first 10 years of ulcerative colitis: results from a population-based inception cohort (IBSEN study). Scand J Gastroenterol. 2009;44:431–440.CrossRefGoogle Scholar
  23. 23.
    Abdalla M, Landerholm K, Andersson P, et al. Risk of rectal cancer after colectomy for patients with ulcerative colitis: a national cohort study. Clin Gastroenterol Hepatol. 2017;15:1055.e1052–1060.e1052.CrossRefGoogle Scholar
  24. 24.
    Myrelid P, Landerholm K, Nordenvall C, et al. Appendectomy and the risk of colectomy in ulcerative colitis: a national cohort study. Am J Gastroenterol. 2017;112:1311–1319.CrossRefGoogle Scholar
  25. 25.
    Fukuda T, Naganuma M, Sugimoto S, et al. The risk factor of clinical relapse in ulcerative colitis patients with low dose 5-aminosalicylic acid as maintenance therapy: a report from the IBD registry. PLoS ONE. 2017;12:e0187737.CrossRefGoogle Scholar
  26. 26.
    Park BJ, Lee KJ, Hwang JC, et al. Relapse rates of ulcerative colitis in remission and factors related to relapse. Korean J Gastroenterol. 2008;52:21–26.PubMedGoogle Scholar
  27. 27.
    Mudireddy P, Scott F, Feathers A, et al. Inflammatory bowel disease: predictors and causes of early and late hospital readmissions. Inflamm Bowel Dis. 2017;23:1832–1839.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Dong Suk Shin
    • 1
  • Jae Hee Cheon
    • 1
    • 2
    Email author
  • Yong Eun Park
    • 1
  • Yehyun Park
    • 1
    • 2
  • Soo Jung Park
    • 1
    • 2
  • Tae Il Kim
    • 1
    • 2
  • Won Ho Kim
    • 1
    • 2
  1. 1.Department of Internal MedicineYonsei University College of MedicineSeoulKorea
  2. 2.Institute of GastroenterologyYonsei University College of MedicineSeoulKorea

Personalised recommendations