Clinical Course, Treatment Strategies, Social and Economic Impact of Ulcerative Colitis: An Overview

The aim of this paper is to provide an overview of the clinical course, predictive factors, and treatment strategies for ulcerative colitis (UC) as well as the social and economic impacts of the disease. Based on review of population-based and observational studies as well as drug trials we state: Extensive colitis, a young age at diagnosis, and the need for glucocorticosteroids at diagnosis are risk factors for requiring surgery. During the past 10-15 years, the advances in the treatment of UC have been characterised by the more widespread use of immunosuppression/ immunomodulation. In particular, TNF-α inhibitors and thiopurines are used to treat UC. TNF-α inhibitors are currently the drug of choice. Topically active GCSs have emerged as valuable and safer alternatives to standard GCSs in moderate to severe colitis; however, GCSs have no role in maintenance therapy. For mild and moderate UC, local or oral 5-ASA is still the drug of choice, and the use of probiotics still is controversial. The risk of colectomy is much lower than reported in studies completed prior to 1990. The surgery rates at 10 years after diagnosis are between 4 and 10% in recent studies, and the colectomy rate for patients with severe UC who require hospitalisation has remained stable at 27%. The potential of medical and surgical care to decrease morbidity, thus improving quality of life and reducing associated indirect costs, is expected to have a significant impact upon the economics of IBD. This effect, however, remains to be evaluated.