Progressing or preserving, disease extent evolution in hospitalized patients with ulcerative colitis in China: a real-world study.

Background: Disease extent of ulcerative colitis (UC) is dynamic, often shows progression or regression over time. However, factors associated with disease progression in long-term follow-ups remain underexplored. Objectives: This study aimed to examine disease extent progression in Chinese patients in a long-term follow-up cohort and identify associated risk factors. Design: Retrospective analysis. Methods: We retrospectively analyzed 800 hospitalized UC patients from 1980 to 2021, and followed up to December 2023. The disease extent was categorized according to the Montreal classification. The Cox regression model was used to identify factors associated with progression. Results: At diagnosis, 19.1% had E1 (ulcerative proctitis), 29.8% had E2 (left-sided UC), and 51.1% had E3 (extensive UC). By the end of follow-up, the proportion of maximum disease extent of E3 cases increased to 74.9%, while E1 and E2 patients decreased to 6.6% and 18.5%, respectively. Cox regression analysis revealed that patients with a history of appendectomy before the onset of disease were at higher risk of disease progression in those initially diagnosed with E1. Lower usage of glucocorticoids, immunosuppressants, and biologics were found in progression to the E3 group than initial E3 group. Lower usage of immunosuppressants and biologics before progression were found in the progressed to E3 group than not progressed to E3 group. Conclusion: Disease extent progression was common in Chinese UC patients. We suggest the necessity of aggressive treatment strategies, especially for early-stage UC patients, to mitigate disease progression and reduce the risk of related complications.