Sa1268 Natural History and Risk Factors for Proctocolectomy in Asian Ulcerative Colitis

Objective: Ulcerative Colitis (UC) is rare in Asia but has seen a rise in prevalence over the past decade. Previous studies have suggested that UC is milder in Asians and fewer Asian patients require proctoproctocolectomy. The aim of the studywas to determine the proportion of Singaporean UC patients who required proctoproctocolectomy and the risk factors associated with the need for surgery in our cohort of patients. Methods: This is a retrospective study of 453 Asian UC patients seen at the Singapore General Hospital (SGH), Changi General Hospital (CGH) and National University of Singapore (NUH) from 1970 to 2011. Data was reviewed from case notes and electronic records. Cox proportional hazards model was used to identify univariate and multivariate risk factors for proctocolectomy. Results: There were 317 (70.0%) Chinese, 69 (15.2%) Indian, 45 (9.9%) Malay, and 22 (4.9%) patients of other Asian ethnicities in the study cohort. Male-to-female ratio was 1.5:1 (268:186). The majority of patients presented between the ages of 30 to 40 years old (28.5%), with no bimodal peak in age presentation. The mean duration from symptom onset to diagnosis was 22.9 months. At diagnosis, 116 (25.6%) patients presented with proctitis, 186 (42.6%) with left sided disease, and 139 (31.8%) with extensive colitis. 63 (13.9%) patients were steroid dependent. Azathioprine was eventually started in 61 (19.2%) Chinese, 19 (27.5%) Indian and 10 (22.2%) Malay patients, while proctocolectomy was required in 33 (10.4%) Chinese, 8 (10.1%) Indian and 4 (8.9%) Malay patients. The most common indications for proctocolectomy was medically refractory ulcerative colitis (64.4%) followed by acute severe colitis (15.6%) and cancer or dysplasia (13.3%). Risk factors associated with proctocolectomy were ESR more than 26 mm/h at diagnosis (p = 0.026), hemogoblin less than 12 g/dl at diagnosis (p = 0.015), steroid dependency (p< 0.0001), hospitalizations due to UC flares (p = 0.028) and extensive colitis (p = 0.037). Multivariate analysis showed that steroid dependency was the only variable independently associated with proctocolectomy (p = 0.001). Cumulative proctocolectomy rates were 3.0% at 1 year, 6.6% at 5 year, 9.2% at 10 year and 23.3% at 30 year. Age at diagnosis, gender, race and time to diagnosis did not affect surgical rates. Conclusion: About 10% of Asian UC patients in Singapore required proctocolectomy. While this is higher than the 3% of Koreans who required surgery for UC, it is lower than what has been reported in Caucasian cohorts. Steroid dependency was the only variable found to be associated with the need for proctocolectomy.