－S 131 －
― F-17 ―
Do patients with ulcerative colitis diagnosed at younger age have more severe disease activity than elderly patients?
Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine
*Jin Ha Lee, Jae Hee Cheon, Tae Il Kim, Won Ho Kim
Background/Aims: Inflammatory bowel disease has classically been thought to demonstrate a bimodal age distribution (i. e. , incidence peak in the second or third decades in life followed by a second, smaller peak in later decades). Ulcerative colitis (UC) is most commonly diagnosed in late adolescence and early adulthood. However, it is not known yet whether these differences in age distribution could affect the variations in clinical features and disease behavior. Thus, we aimed to compare the clinical features and disease behavior of UC according to its onset age. Methods: A total of 481 patients with UC, diagnosed and treated between 1990 and 2006 at Severance Hospital, Yonsei University, Seoul, Korea and followed for at least 1 year, were included in this study. The patients were divided into two groups according to their age at diagnosis of UC: the elderly group consisted of those of age over 40-year-old; the younger group those of age under 40-year-old. According to these age groups, clinical findings at diagnosis, disease extent, treatment modalities used, cumulative admission rates, and cumulative relapse rates were analyzed. Results: Forty two percent (201) of patients with UC had been diagnosed past the age of 40 years. Fever (18% vs 10%, p<0.05) and diarrhea (2.08 vs 1.74, p<0.05) at its initial presentation were predominant in the younger group. However, the other parameters of clinical findings including UC activity index at diagnosis, treatment modalities used, cumulative admission rates, and cumulative relapse rates did not show any significant differences between the two groups. Conclusions: Some clinical features and disease extent appear to be severe in UC patients when the disease was diagnosed at younger age. However, there disease course and prognosis might not be different from those of their older counterpart.
― F-18 ―
Long Term Clinical Outcomes and Prognostic Factors of Intestinal Behcet's Disease after Medical Treatments
Department of Internal Medicine and Institute of Gastroenterology
*Moon Jae Chung, Jae Hee Cheon, Seung Up Kim, Duk Hwan Kim, Jae Jun Park, Eun Soo Kim, Tae Il Kim, and Won Ho Kim
Background: Little is known about the efficacy of medical treatments in intestinal Behcet's disease and its long-term clinical course. Objective : The aims of our study were to evaluate the short- or long-term efficacy of medical treatments in intestinal Behcet's disease and to assess the factors to predict the recurrence during medical treatments of intestinal Behcet's disease. Methods: A retrospective review of the medical records for the patients who were diagnosed and treated as intestinal Behcet's disease at Severance Hospital from year 1992 to 2007 was performed. Clinical symptoms at the time of diagnosis, laboratory results, endoscopic findings, types of medications, remission rate, and long-term clinical course were investigated. Results: A total of 109 patients were included. Median age was 40 years (range 16-60 years) and male-to-female rate was 1:1.271.The mean follow up period of patients with remission was 103.9 months. Medications administered were 5-ASA in 97 patients (89.0%), corticosteroid in 37 patients (33.9%), and immunosuppressants such as azathioprine and 6-mercaptopurine in 4 patients (3.7%). Initial remission rate to the medications evaluated at 8 weeks after initiation of treatment was 89.0% (97 patients). The recurrence probability of the intestinal lesions was 23.5% at two years and 40.6% at five years after complete remission with medical treatment. Previous history of surgery at the time of diagnosis (HR 5.307, 95% CI 0.996-28.272, p = 0.051), deep ulcer on colonoscopy (HR 3.005, 95% CI 1.312-6.883, p = 0.009), not achieving remission at 8 weeks (HR 4.920, 95% CI 1.304-18.563, p = 0.019) were the predictive factors for recurrence during the course of the disease. Conclusions : The results of our study demonstrate that medical treatments for intestinal Behcet's disease are quite effective in inducing and maintaining remission. Nonetheless, a considerable number of patients experience disease relapse eventually. Careful observations and intensive treatments should be carried out especially on patients with previous history of surgery at the time of diagnosis, with deep ulcer on colonoscopy, and with no remission at 8 weeks after initiation of medication.
