ASPECTE EPIDEMIOLOGICE SI CLINICO-EVOLUTIVE ALE COLITEI ULCERATIVE. STUDIU PROSPECTIV PE 5 ANI INTR-UN CENTRU TERTIAR DE GASTROENTEROLOGIE

INTRODUCTION: Over the last 3 decades, the improvement of diagnosis criteria in idiopathic inflammatory bowel diseases led to an increased interest on a global level for this pathology. The clinical evolution of the disease, the prognosis and any associated complications are of major importance for the patient and the treating physician. THE AIMS of the study has been to determine the epidemiological and clinical evolutive aspects of the patients with UC in a tertiary Gastroenterology center. MATERIAL AND METHOD. We have performed a prospective observational study on a batch of patients who were being monitored at our clinic in the period January 2007 – December 2011. The lot of study comprised 160 patients with UC. Each patient had a - patient’s record - in which we collected the demographic data, family history of inherited and collateral diseases, signs and symptomatology of the disease, the biological markers. There have been evaluated the extraintestinal and bowel complications, the treatment for each patient at the onset of the disease, during the active periods of the disease, and as well in the remission phase of the disease (clinical and endoscopic). RESULTS: The annual incidence of UC patients experienced an ascending trend from 12 newly diagnosed cases in 2007 to 35 new cases in 2010, respectively 30 new cases in 2011. Moreover, the number of monitored UC patients has increased from 58 in 2007 up to 160 in 2011. In the studied lot we had an approximate equal distribution on gender of the patients: 51% women, 49% men. Most of the patients were from of an active urban environment (71%). The minimum onset age of UC was 15, and the maximum age 80. 61% of the patients were non-smokers, and 25% active smokers. According to the extension of lesions, 60% of the patients had left-sided colitis, 22% extensive left-sided colitis, and 17% proctitis. According to the severity of the disease, 54% of the patients had moderate flares of disease, 24% mild flares, 15% severe flares and only 7% have been in clinical and endoscopical remission during the analyzed period. CONCLUSIONS: According to the results obtained UC has an ascending trend of incidence, fact that imposes an appropriate management of the patients with diarrheic syndrome to which there are associated or not pathologic elements (blood, mucus). These data demonstrate the usefulness of endoscopic monitoring in patients with an older dated disease and of those with an extensive form of the disease, including pancolitis, as well as the usefulness of early colectomy in patients with severe dysplasia. Keywords: Ulcerative colitis, Endoscopy, Colorectal cancer, Colectomy. INTRODUCERE: Pe parcursul ultimelor 3 decenii, imbunatatirea criteriilor de diagnostic ale afectiunilor inflamatorii intestinale idiopatice a dus la cresterea interesului pe plan mondial pentru aceasta patologie. Evolutia clinica a afectiunii, prognosticul si orice complicatii asociate sunt de importanta majora pentru pacient si medicul curant.SCOPUL STUDIULUI a fost de a determina aspectele epidemiologice si clinico-evolutive ale pacientilor cu colita ulcerativa (CU) intr-un centru tertiar de Gastroenterologie.MATERIAL SI METODA: Am efectuat un studiu prospectiv, observational, pe un lot de pacienti aflati in dispensarizarea clinicii noastre in perioada ianuarie 2007 – decembrie 2011. Lotul de studiu a cuprins 160 de pacienti cu CU. Diagnosticul bolii a fost stabilit in baza examenului clinic, endoscopic si histopatologic. Fiecare pacient a avut o ˮfisa a pacientuluiˮ in care s-au colectat datele demografice, antecedentele familiale si heredo-colaterale, semnele si simptomele bolii, parametrii biologici. Au fost evaluate complicatiile intestinale si extraintestinale, tratamentul fiecarui pacient la debutul bolii, in perioadele de activitate ale bolii, precum si in etapa de remisiune a afectiunii (clinica si endoscopica). Analiza statistica. Datele au fost procesate cu ajutorul instrumentelor statistice in Excel (Microsoft Excel 2003).REZULTATE: Incidenta anuala a pacientilor cu CU a cunoscut un trend ascendent: de la 12 cazuri nou diagnosticate in 2007 s-a ajuns la 35 cazuri noi in 2010, respectiv 30 cazuri noi in 2011. De asemenea, a crescut numarul pacientilor dispensarizati cu CU de la 58 in 2007 la 160 in 2011. Am avut o repartitie aproximativ egala pe sexe a pacientilor: 51% femei, 49% barbati. Majoritatea pacientilor au fost din mediul urban (71%). Varsta minima de debut a CU a fost de 15 ani, iar varsta maxima 80 ani. 61% dintre pacienti au fost nefumatori, iar 25% fumatori activi. Dupa extinderea leziunilor, 60% dintre pacienti au avut colita stanga, 22% colita stanga extinsa, iar 17% proctita. Dupa severitatea bolii, 54% dintre pacienti au avut pusee moderate de boala, 24% pusee usoare, 15% pusee severe si numai 7% au fost in remisiune clinica si endoscopica pe perioada examinata.CONCLUZII: Conform rezultatelor obtinute CU are un trend ascendent al incidentei, ceea ce impune un management corespunzator al pacientilor cu sindrom diareic la care se asociaza sau nu elemente patologice (sange, mucus). Aceste date demonstreaza utilitatea supravegherii endoscopice la pacientii cu boala de data veche si la cei cu forma extinsa a bolii, inclusiv pancolita, precum si utilitatea colectomiei precoce la pacintii cu diplazie severa. Cuvie cheie: colita ulcerativa, endoscopie, cancer colorectal, interventie chirurgical