Ulcerative Colitis: Are We Neglecting Its Progressive Character.
Introduction
Ulcerative colitis (UC) is a chronic disease but its progressive character, with structural damage, is insufficiently studied.


Objectives
To analyze a group of patients without referral bias, regarding its clinical course, the morphological damage, and functional status.


Methods
We evaluated UC patients diagnosed between January 1, 2000 and December 31, 2004, living in the direct referral area of the hospital and determined the medication use, colectomy rate, structural damage ("lead pipe," stenosis, pseudopolyps, fibrous bridges), and anorectal function (prospective evaluation with the Cleveland Clinic Incontinence Score [CCIS] and the Fecal Incontinence Quality of Life Scale).


Results
We identified 104 patients, 47% female, with a mean age at diagnosis of 38 ± 17 years, 24% with proctitis, 57% with left colitis, and 19% with pancolitis. In 3 patients, it was not possible to obtain follow-up data. Of the studied patients, 56% needed corticosteroid therapy, 38% immunosuppressants, and 16% anti-tumor necrosis factors (anti-TNFs). After a mean follow-up of 13 ± 2 years, we found structural damage in 25 patients (24%): 5% with proctocolectomy, 15% with "lead pipe," 16% with pseudopolyps, and 3% with stenosis and fibrous bridges. Reference to functional anorectal disorders was identified in 49%, mostly previous and self-limited episodes of incontinence, but including persistent incontinence in 10% (CCIS 8 ± 4.8). There was an increased incidence of structural damage and anorectal dysfunction in patients who needed corticosteroid therapy (p = 0.001), immunosuppressants (p < 0.001), and anti-TNFs (p = 0.002) and an association of structural damage with anorectal dysfunction (p < 0.001). There was no association between age and anorectal dysfunction, including incontinence episodes.


Conclusions
UC is a disease with structural and functional consequences in a significant subset of patients. This should be incorporated when defining the therapeutic strategy.
['Massinha|Paulo|P|', 'Portela|Francisco|F|', 'Campos|Sara|S|', 'Duque|Gabriela|G|', 'Ferreira|Manuela|M|', 'Mendes|Sofia|S|', 'Ferreira|Ana Margarida|AM|', 'Sofia|Carlos|C|', 'Tomé|Luís|L|']
Ulcerative colitis Colon Disease progression Inflammatory bowel disease Prognosis