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J Clin Gastroenterol
221
J Clin Gastroenterol
Yamamoto-Furusho
Statistical Analysis
Descriptive statistics are expressed as mean and
standard deviation. New cases of UC were reported yearly
as frequency. Data were analyzed by Student t test for
numerical variables and w2 test for nominal variables. The
P value was 2-tailed and less than 0.05 was considered
statistically signicant. The data analysis was performed
with SSPS version 14.0 for Windows.
RESULTS
A total of 848 patients were diagnosed with UC
between 1987 and 2006 at this hospital. The frequency of
new cases with UC increased over the time (Fig. 1). The
mean of new UC cases increased annually from 28.8 in the
rst period (1987 to 1996) to 76.1 in the second period (1997
to 2006) (P<0.00008). The incidence increased 2.6-fold
comparing both periods of time. The age-group distribution
of the patients were as follows: 21 to 30 years (37.1%); 31 to
40 years (25.5%); 51 to 60 years (12.9%); 41 to 50 years
(10.6%); under 20 years (13.2%) and over 60 years of age
(1.3%) as shown in Figure 2.
During the whole study period (1987 to 2006), 467
female and 382 male patients with UC were analyzed. The
mean age at diagnosis was 31.3 12.3 years; the male to
female ratio (0.9:1.0) was equal. Most of the patients are
residing in urban areas (91.4%) and a total of 775 (91.3%)
patients were nonsmokers and 73 (8.6%) patients were exsmokers. A prior history of appendectomy was revealed in
20 cases (2.35%). Familial aggregation was present in 57
(6.78%) cases (50 patients with rst-degree relatives and
350
300
Number of cases
250
200
150
100
50
0
< 10
10 to 20
21 to 30
31 to 40
41 to 50
51 to 60
> 60
Age at diagnosis
Surgery
During this period, 86 (10.1%) of the UC patients
underwent proctocolectomy, 84 patients had pancolitis and
only 2 cases had left-sided colitis. The most common causes
of colectomy were: failed to medical treatment (89.9%),
toxic megacolon (5.6%), perforation (3.7%), cancer
(0.5%), and massive hemorrhage (0.3%). Forty-three
patients underwent colectomy in their rst 5 years since
diagnosis. Four patients developed dysplasia or colorectal
cancer 15 years after the initial diagnosis.
Extraintestinal Manifestations
Three hundred fty-two UC patients (41.5%) had
extraintestinal manifestations that included: arthritis
100
80
Pancolitis (E3)
60
Year 06
Year 05
Year 03
Year 04
Year 01
Year 02
Year 99
Year 00
Year 97
Year 98
Year 96
Year 90
Year 88
Year 89
Year 87
Year 94
Proctitis (E1)
Year 95
20
Year 93
Left-sided colitis
(E2)
Year 91
40
Year 92
120
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J Clin Gastroenterol
30
Frequency
25
20
15
10
Ankylosing
spondilitis
Uveitis
Pyoderma
Sacroiliitis
Erythema
nodosum
PSC
Arthropathy
(24.4%), PSC (10.5%), erythema nodosum (4.4%), sacroiliitis (3.1%), pyoderma gangrenosum (2.2%), anterior
uveitis (2.0%), and ankylosing spondylitis (1.1%) as shown
in Figure 4.
Medical Treatment
Most of the patients, 762 (89.8%) were taking
sulfasalazine or 5-aminosalicylic acid (5-ASA); 282 (33.3%)
used oral or systemic glucocorticosteroids; 237 (28%) were
taking azathioprine and other treatments (0.5%). Topical
medication was used in 110 patients with proctitis (13%)
based on 5-ASA. Sulfasalazine or 5-ASA was used over the
course of the follow-up. Oral and systemic glucocorticosteroids at dierent points in time and azathioprine was added
during the course of disease (Table 1).
DISCUSSION
To the best of our knowledge, this is the rst Latin
America study that reports the clinical epidemiology in a
large cohort of Mexican patients with UC. Some reports
have suggested a lower incidence and milder course of UC
in Latin America.3 However, the epidemiology and clinical
characteristics are still unknown. Variable incidence and
prevalence rates, and clinical features of UC in dierent
ethnic populations, may provide insight into the pathophysiology of UC. In the developing world, true populationbased registries are hard to nd, and consequently studies
are commonly hospital-based.
An important nding from this study is the increasing
frequency of new UC cases diagnosed in the last decade
in Mexico. The possible explanations of this increased
25.5%
64.3%
33.3%
28%
2%
1.17%
0.6%
223
J Clin Gastroenterol
Yamamoto-Furusho
224