Natural History of Adult Ulcerative Colitis in Population-based Cohorts: A Systematic Review

Mathurin Fumery*, Siddharth Singh, Parambir S. Dulai, Corinne Gower-Rousseau, Laurent Peyrin-Biroulet, William J. Sandborn

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

285 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)343-356.e3
JournalClinical Gastroenterology and Hepatology
Issue number3
StatePublished - Mar 2018
Externally publishedYes


  • Natural History
  • Population-based
  • Ulcerative Colitis

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology


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