Clinical Characteristics, Treatment Outcomes, and Risk Factors for Complications in Ulcerative Colitis

Abstract

Background: Ulcerative Colitis (UC) is a chronic inflammatory bowel disease with significant morbidity. This study aimed to characterize clinical patterns, treatment responses, and risk factors for complications in UC patients. Methods: Data from 450 UC patients (aged ≥18 years) treated at a tertiary center (2021–2023) were retrospectively analyzed. Demographics, disease severity (Montreal classification), treatment modalities (5-ASA, immunosuppressants, biologics), and complications (colonic stricture, toxic megacolon, colorectal cancer) were evaluated. Multivariate logistic regression identified risk factors for severe complications.

Results: Median age at diagnosis was 32 years (IQR:25–40), with 52% male patients. Pancolitis (Montreal E3) was present in 38% (171/450), and 22% (99/450) had prior corticosteroid failure. Biologic therapy (adalimumab, infliximab) was initiated in 35% (158/450), achieving clinical remission in 68% at 12 months. Severe complications occurred in 12% (54/450), including strictures (6.7%) and toxic megacolon (3.3%). Multivariate analysis identified pancolitis (OR=2.89, 95%CI:1.62–5.16, p<0.001), corticosteroid failure (OR=2.17, 95%CI:1.28–3.68, p=0.004), and delayed diagnosis (>6 months) (OR=1.92,95%CI:1.15–3.18, p=0.013) as independent risk factors for complications.

Conclusion: Pancolitis, corticosteroid failure, and delayed diagnosis increase the risk of severe complications in UC. Early initiation of biologic therapy in high-risk patients may improve outcomes.