SNFGE SNFGE
 
Thématique :
- MICI
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Stéphane NAHON
Coup de coeur :
 
 
Clinical Gastroenterology and Hepatology
  2018/03  
 
  2018 Mar;16(3):343-356.e3.  
  doi: 10.1016/j.cgh.2017.06.016.  
 
  Natural History of Adult Ulcerative Colitis in Population-based Cohorts: A Systematic Review.  
 
  Fumery M, Singh S, Dulai PS, Gower-Rousseau C, Peyrin-Biroulet L, Sandborn WJ  
  https://www.ncbi.nlm.nih.gov/pubmed/28625817  
 
 

Abstract

BACKGROUND & AIMS:

A comprehensive knowledge of the natural history of ulcerative colitis (UC) helps understand disease evolution, identify poor prognostic markers and impact of treatment strategies, and facilitates shared decision-making. We systematically reviewed the natural history of UC in adult population-based cohort studies with long-term follow-up.

METHODS:

Through a systematic literature review of MEDLINE through March 31, 2016, we identified 60 studies performed in 17 population-based inception cohorts reporting the long-term course and outcomes of adult-onset UC (n = 15,316 UC patients).

RESULTS:

Left-sided colitis is the most frequent location, and disease extension is observed in 10%-30% of patients. Majority of patients have a mild-moderate course, which is most active at diagnosis and then in varying periods of remission or mild activity; about 10%-15% of patients experience an aggressive course, and the cumulative risk of relapse is 70%-80% at 10 years. Almost 50% of patients require UC-related hospitalization, and 5-year risk of re-hospitalization is ∼50%. The 5-year and 10-year cumulative risk of colectomy is 10%-15%; achieving mucosal healing is associated with lower risk of colectomy. About 50% of patients receive corticosteroids, although this proportion has decreased over time, with a corresponding increase in the use of immunomodulators (20%) and anti-tumor necrosis factor (5%-10%). Although UC is not associated with an increased risk of mortality, it is associated with high morbidity and work disability, comparable to Crohn's disease.

CONCLUSIONS:

UC is a disabling condition over time. Prospective cohorts are needed to evaluate the impact of recent strategies of early use of disease-modifying therapies and treat-to-target approach with immunomodulators and biologics. Long-term studies from low-incidence areas are also needed.

 

 
Question posée
 
Quelle est l’histoire naturelle de la RCH en population ?
 
Question posée
 
Il s’agit d’une revue systématique de la littérature analysant les études en population sur la RCH. Les formes E2 sont les plus fréquentes. Une extension de la localisation est observée dans 10-30% des cas. 10%–15% des patients ont une forme agressive de la maladie. Le risque cumulé de rechute est de 70%–80% à 10 ans. Le risque cumulé de colectomie à 5 et 10 ans est de 10%–15%. La cicatrisation muqueuse est associée à un risque plus faible de colectomie. Environ 50% des patients sont traités par corticoïdes, proportion qui diminue avec le temps, correspondant à une augmentation de l’utilisation des immunosuppresseurs (20%) et des anti–TNF (5%–10%). Le RCH n’est pas associée à un surrisque de mortalité tout comme la MC à une morbidité plus élevée et à un handicap fonctionnel.
 
Commentaires

Très belle revue de la littérature qui permet de mieux connaître l’histoire naturelle de la maladie.

 
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