Background and Aims: Few population-based cohort studies have assessed the disease course of ulcerative colitis [UC] in the era of biological therapy and widespread use of immunomodulators. The aim of this study was to assess the 5-year outcome and disease course of patients with UC in the Epi-IBD cohort. Methods: In a prospective, population-based inception cohort of unselected patients with UC, patients were followed up from the time of their diagnosis, which included the collection of their clinical data, demographics, disease activity, medical therapy, and rates of surgery, cancers, and deaths. Associations between outcomes and multiple covariates were analysed by Cox regression analysis. Results: A total of 717 patients were included in the study. During follow-up, 43 [6%] patients underwent a colectomy and 163 [23%] patients were hospitalised. Of patients with limited colitis [distal to the left flexure], 90 [21%] progressed to extensive colitis. In addition, 92 [27%] patients with extensive colitis experienced a regression in disease extent, which was associated with a reduced risk of hospitalisation (hazard ratio [HR]: 0.5 95% CI: 0.3-0.8]. Overall, patients were treated similarly in both geographical regions; 80 [11%] patients needed biological therapy and 210 [29%] patients received immunomodulators. Treatment with immunomodulators was found to reduce the risk of hospitalisation [HR: 0.5 95% CI: 0.3-0.8]. Conclusions: Although patients in this population-based cohort were treated more aggressively with immunomodulators and biological therapy than in cohorts from the previous two decades, their disease outcomes, including colectomy rates, were no different. However, treatment with immunomodulators was found to reduce the risk of hospitalisation.

1st Department of Medicine Semmelweis University Budapest Hungary

1st Department of Medicine Semmelweis University Budapest Hungary Division of Gastroenterology McGill University Health Center Montreal QC Canada

American Gastroenterology Center Nicosia Cyprus

Clinic of Gastroenterology University of Medicine 'Victor Babes' Timisoara Romania

Department of Gastroenterology and Alimentary Tract Surgery Tampere University Hospital Tampere Finland University of Tampere Tampere Finland

Department of Gastroenterology and Hepatology Soroka Medical Center and Ben Gurion University of the Negev Beer Sheva Israel

Department of Gastroenterology Centro Hospitalar de São João EPE Porto Portugal

Department of Gastroenterology Centro Hospitalar de São João EPE Porto Portugal Department of Biomedicine Institute of Pharmacology Faculty of Medicine of Porto University Porto Portugal

Department of Gastroenterology Faculty of Medicine and Health Örebro University Örebro Sweden

Department of Gastroenterology Herlev and Gentofte Hospital University of Copenhagen Copenhagen Denmark

Department of Gastroenterology Hospital Alvaro Cunqueiro Instituto Investigación Sanitaria Galicia Sur EOXI de Vigo Vigo Spain

Department of Gastroenterology Moscow Regional Research Clinical Institute Moscow Russian Federation

Department of Gastroenterology Nordsjællands Hospital University of Copenhagen Frederikssund Denmark

Department of Gastroenterology State University of Medicine and Pharmacy of the Republic of Moldova Chisinau Republic of Moldova

Department of Gastroenterology University Hospital of Ioannina Ioannina Greece

Department of Medicine Herning Central Hospital Herning Denmark

Department of Surgical Oncological and Gastroenterological Sciences Azienda University of Padua Padova Italy

Division of Gastroenterology and Hepatology University Hospital Center Zagreb Zagreb Croatia School of Medicine University of Zagreb Zagreb Croatia

Division of Gastroenterology Mater Dei Hospital Msida Malta

Division of Gastroenterology Tartu University Hospital University of Tartu Tartu Estonia

Gastroenterology Department Odense University Hospital Odense Denmark

Gastroenterology Department Slagelse Hospital Slagelse Denmark

Gastroenterology Unit Epimad Registry CHU Amiens Sud Amiens University Hospital Amiens France

IBD Clinical and Research Centre ISCARE Prague Czech Republic

IBD Clinical and Research Centre ISCARE Prague Czech Republic Institute of Pharmacology 1st Faculty of Medicine Charles University Prague Prague Czech Republic

IBD Department St Mark's Hospital London UK

IBD Unit Hull and East Yorkshire NHS Trust Hull UK

Institute for Digestive Research Medical Academy Lithuanian University of Health Sciences Kaunas Lithuania

Institute for Digestive Research Medical Academy Lithuanian University of Health Sciences Kaunas Lithuania Department of Gastroenterology Medical Academy Lithuanian University of Health Sciences Kaunas Lithuania

Medical Department National Hospital of the Faroe Islands Torshavn Faroe Islands

Medical Department Regional Hospital of Viborg Viborg Denmark

Medical Department Regional Hospital of Viborg Viborg Denmark Focused Research Unit for Molecular Diagnostic and Clinical Research [MOK] IRS Center Sonderjylland Hospital of Southern Jutland Aabenraa Denmark Institute of Molecular Medicine University of Southern Denmark Odense Denmark

Public Health Epidemiology and Economic Health Registre Epimad Lille University and Hospital Lille France Lille Inflammation Research International Center LIRIC Lille University Lille France

U O Gastroenterologia ed Endoscopia digestiva Hospital Morgagni Pierantoni Forlì Italy

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$a Burisch, Johan $u Department of Gastroenterology, Nordsjællands Hospital, University of Copenhagen, Frederikssund, Denmark.

245    10

$a Natural Disease Course of Ulcerative Colitis During the First Five Years of Follow-up in a European Population-based Inception Cohort-An Epi-IBD Study / $c J. Burisch, KH. Katsanos, DK. Christodoulou, L. Barros, F. Magro, N. Pedersen, J. Kjeldsen, Z. Vegh, PL. Lakatos, C. Eriksson, J. Halfvarson, M. Fumery, C. Gower-Rousseau, M. Brinar, S. Cukovic-Cavka, I. Nikulina, E. Belousova, S. Myers, S. Sebastian, G. Kiudelis, L. Kupcinskas, D. Schwartz, S. Odes, IP. Kaimakliotis, D. Valpiani, R. D'Incà, R. Salupere, S. Chetcuti Zammit, P. Ellul, D. Duricova, M. Bortlik, A. Goldis, HAL. Kievit, A. Toca, S. Turcan, J. Midjord, KR. Nielsen, KW. Andersen, V. Andersen, R. Misra, N. Arebi, P. Oksanen, P. Collin, L. de Castro, V. Hernandez, E. Langholz, P. Munkholm, Epi-IBD Group,

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$a Background and Aims: Few population-based cohort studies have assessed the disease course of ulcerative colitis [UC] in the era of biological therapy and widespread use of immunomodulators. The aim of this study was to assess the 5-year outcome and disease course of patients with UC in the Epi-IBD cohort. Methods: In a prospective, population-based inception cohort of unselected patients with UC, patients were followed up from the time of their diagnosis, which included the collection of their clinical data, demographics, disease activity, medical therapy, and rates of surgery, cancers, and deaths. Associations between outcomes and multiple covariates were analysed by Cox regression analysis. Results: A total of 717 patients were included in the study. During follow-up, 43 [6%] patients underwent a colectomy and 163 [23%] patients were hospitalised. Of patients with limited colitis [distal to the left flexure], 90 [21%] progressed to extensive colitis. In addition, 92 [27%] patients with extensive colitis experienced a regression in disease extent, which was associated with a reduced risk of hospitalisation (hazard ratio [HR]: 0.5 95% CI: 0.3-0.8]. Overall, patients were treated similarly in both geographical regions; 80 [11%] patients needed biological therapy and 210 [29%] patients received immunomodulators. Treatment with immunomodulators was found to reduce the risk of hospitalisation [HR: 0.5 95% CI: 0.3-0.8]. Conclusions: Although patients in this population-based cohort were treated more aggressively with immunomodulators and biological therapy than in cohorts from the previous two decades, their disease outcomes, including colectomy rates, were no different. However, treatment with immunomodulators was found to reduce the risk of hospitalisation.

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$a Katsanos, Konstantinos H $u Department of Gastroenterology, University Hospital of Ioannina, Ioannina, Greece.

700    1_

$a Christodoulou, Dimitrios K $u Department of Gastroenterology, University Hospital of Ioannina, Ioannina, Greece.

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$a Barros, Luisa $u Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal.

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$a Magro, Fernando $u Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal. Department of Biomedicine, Institute of Pharmacology, Faculty of Medicine of Porto University, Porto, Portugal.

700    1_

$a Pedersen, Natalia $u Gastroenterology Department, Slagelse Hospital, Slagelse, Denmark.

700    1_

$a Kjeldsen, Jens $u Gastroenterology Department, Odense University Hospital, Odense, Denmark.

700    1_

$a Vegh, Zsuzsanna $u First Department of Medicine, Semmelweis University, Budapest, Hungary.

700    1_

$a Lakatos, Peter L $u First Department of Medicine, Semmelweis University, Budapest, Hungary. Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada.

700    1_

$a Eriksson, Carl $u Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.

700    1_

$a Halfvarson, Jonas, $d 1970- $7 xx0245713 $u Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.

700    1_

$a Fumery, Mathurin $u Gastroenterology Unit, Epimad Registry, CHU Amiens Sud, Amiens University Hospital, Amiens, France.

700    1_

$a Gower-Rousseau, Corinne $u Public Health, Epidemiology and Economic Health, Registre Epimad, Lille University and Hospital, Lille, France. Lille Inflammation Research International Center LIRIC, Lille University, Lille, France.

700    1_

$a Brinar, Marko $u Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia. School of Medicine, University of Zagreb, Zagreb, Croatia.

700    1_

$a Cukovic-Cavka, Silvija $u Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia. School of Medicine, University of Zagreb, Zagreb, Croatia.

700    1_

$a Nikulina, Inna $u Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation.

700    1_

$a Belousova, Elena $u Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation.

700    1_

$a Myers, Sally $u IBD Unit, Hull and East Yorkshire NHS Trust, Hull, UK.

700    1_

$a Sebastian, Shaji $u IBD Unit, Hull and East Yorkshire NHS Trust, Hull, UK.

700    1_

$a Kiudelis, Gediminas $u Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.

700    1_

$a Kupcinskas, Limas $u Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania. Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.

700    1_

$a Schwartz, Doron $u Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel.

700    1_

$a Odes, Selwyn $u Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel.

700    1_

$a Kaimakliotis, Ioannis P $u American Gastroenterology Center, Nicosia, Cyprus.

700    1_

$a Valpiani, Daniela $u U.O. Gastroenterologia ed Endoscopia digestiva, Hospital Morgagni Pierantoni, Forlì, Italy.

700    1_

$a D'Incà, Renata $u Department of Surgical, Oncological and Gastroenterological Sciences, Azienda, University of Padua, Padova, Italy.

700    1_

$a Salupere, Riina $u Division of Gastroenterology, Tartu University Hospital, University of Tartu, Tartu, Estonia.

700    1_

$a Chetcuti Zammit, Stefania $u Division of Gastroenterology, Mater Dei Hospital, Msida, Malta.

700    1_

$a Ellul, Pierre $u Division of Gastroenterology, Mater Dei Hospital, Msida, Malta.

700    1_

$a Duricova, Dana $u IBD Clinical and Research Centre, ISCARE, Prague, Czech Republic.

700    1_

$a Bortlik, Martin $u IBD Clinical and Research Centre, ISCARE, Prague, Czech Republic. Institute of Pharmacology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.

700    1_

$a Goldis, Adrian $u Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania.

700    1_

$a Kievit, Hendrika Adriana Linda $u Department of Medicine, Herning Central Hospital, Herning, Denmark.

700    1_

$a Toca, Alina $u Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova.

700    1_

$a Turcan, Svetlana $u Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova.

700    1_

$a Midjord, Jóngerð $u Medical Department, National Hospital of the Faroe Islands, Torshavn, Faroe Islands.

700    1_

$a Nielsen, Kári Rubek $u Medical Department, National Hospital of the Faroe Islands, Torshavn, Faroe Islands.

700    1_

$a Andersen, Karina Winther $u Medical Department, Regional Hospital of Viborg, Viborg, Denmark.

700    1_

$a Andersen, Vibeke $u Medical Department, Regional Hospital of Viborg, Viborg, Denmark. Focused Research Unit for Molecular Diagnostic and Clinical Research [MOK], IRS-Center Sonderjylland, Hospital of Southern Jutland, Aabenraa, Denmark. Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.

700    1_

$a Misra, Ravi $u IBD Department, St Mark's Hospital, London, UK.

700    1_

$a Arebi, Naila $u IBD Department, St Mark's Hospital, London, UK.

700    1_

$a Oksanen, Pia $u Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland. University of Tampere, Tampere, Finland.

700    1_

$a Collin, Pekka $u Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland. University of Tampere, Tampere, Finland.

700    1_

$a de Castro, Luisa $u Department of Gastroenterology. Hospital Alvaro Cunqueiro, Instituto Investigación Sanitaria Galicia Sur, EOXI de Vigo, Vigo, Spain.

700    1_

$a Hernandez, Vicent $u Department of Gastroenterology. Hospital Alvaro Cunqueiro, Instituto Investigación Sanitaria Galicia Sur, EOXI de Vigo, Vigo, Spain.

700    1_

$a Langholz, Ebbe $u Department of Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.

700    1_

$a Munkholm, Pia $u Department of Gastroenterology, Nordsjællands Hospital, University of Copenhagen, Frederikssund, Denmark.

710    2_

$a Epi-IBD Group

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