TY - JOUR
T1 - Acute Severe Ulcerative Colitis Patients From Asia Have Lower Colectomy Risk Than Patients From Australasia
AU - Fernandes, Richard Gareth
AU - Kim, Dong Hyun
AU - Ruddick-Collins, Leonie
AU - Vasudevan, Abhinav
AU - Brownson, Anthony Robert
AU - Ngoi, Benjamin
AU - Lin, Chun Chi
AU - Haifer, Craig
AU - Kim, Dae Sung
AU - Swe, Ei
AU - Wright, Emily Kate
AU - Song, Eun Mi
AU - Mahy, Gillian
AU - Moore, Gregory Thomas
AU - Lee, Hyun Seok
AU - Kim, Hyun Soo
AU - Zhang, Jennifer
AU - Yan Mak, Joyce Wing
AU - Lee, Jun
AU - Lynch, Kate
AU - Gazelakis, Kathryn
AU - Rice, Katie
AU - Kim, Kyeong Ok
AU - Liu, Jing
AU - Lilian Bracken, Lucy Mary
AU - Garg, Mayur
AU - Schultz, Michael
AU - Clark, Nicholas
AU - Cao, Qian
AU - Gilmore, Robert
AU - Park, Sang Hyoung
AU - Kim, Seong Jung
AU - Sagami, Shintaro
AU - Wei, Shu Chen
AU - Kashkooli, Soleiman
AU - Schildkraut, Tamar
AU - Lin, Wei Chen
AU - Hsu, Wen Hung
AU - Lee, Yoo Jin
AU - Kim, Eun Soo
AU - Begun, Jakob
AU - Kobayashi, Taku
AU - An, Yoon Kyo
N1 - Publisher Copyright:
© 2025 American Gastroenterological Association Institute.
PY - 2026/7
Y1 - 2026/7
N2 - Background & Aims The incidence of ulcerative colitis (UC) and acute severe UC (ASUC) is rapidly increasing in Asia but remains lower than Australia and New Zealand (ANZ). Studies in Asian countries report differences in UC characteristics and lower colectomy risk. We aimed to compare ASUC characteristics and outcomes in Asia and ANZ. Methods This was a multinational, multicenter retrospective cohort study of consecutive patients hospitalized with ASUC meeting Truelove and Witts’ criteria from January 2015 to December 2020, across 14 hospitals in 4 Asian countries and 9 ANZ hospitals. Results A total of 861 patients were included, with 430 from Asia and 431 from ANZ. Baseline characteristics in the Asian and ANZ cohorts differed significantly, most notably with the Asian cohort having a lower proportion with an IBD family history ( P < .001), more extensive disease at diagnosis ( P < .001), and worse endoscopic severity ( P < .001). At admission, significantly less Asian patients were currently taking corticosteroids, thiopurines, and biologics, and less had previous exposure to biologics ( P < .005). More Asian patients were discharged on 5-aminosalicylates ( P = .014), and fewer were prescribed corticosteroids ( P = .049), thiopurines ( P < .001), or advanced therapies ( P < .001) on discharge, but more remained corticosteroid-dependent on follow-up ( P < .029). The Asian cohort had lower rates of corticosteroid failure (21.5% vs 57.2%; P < .001), inpatient colectomy (2.8% vs 10.9%; P < .001), 1-year colectomy (4.7% vs 22.5%; P < .001), and readmission with ASUC within 12 months (9.3% vs 16.1%; P < .001), validated using a propensity score matched cohort. Conclusions The characteristics of patients with ASUC in Asia differ significantly from ANZ. Despite worse endoscopic severity and more extensive disease, the Asian ASUC cohort appears more corticosteroid-responsive with significantly lower colectomy rates and less requirement for advanced therapies.
AB - Background & Aims The incidence of ulcerative colitis (UC) and acute severe UC (ASUC) is rapidly increasing in Asia but remains lower than Australia and New Zealand (ANZ). Studies in Asian countries report differences in UC characteristics and lower colectomy risk. We aimed to compare ASUC characteristics and outcomes in Asia and ANZ. Methods This was a multinational, multicenter retrospective cohort study of consecutive patients hospitalized with ASUC meeting Truelove and Witts’ criteria from January 2015 to December 2020, across 14 hospitals in 4 Asian countries and 9 ANZ hospitals. Results A total of 861 patients were included, with 430 from Asia and 431 from ANZ. Baseline characteristics in the Asian and ANZ cohorts differed significantly, most notably with the Asian cohort having a lower proportion with an IBD family history ( P < .001), more extensive disease at diagnosis ( P < .001), and worse endoscopic severity ( P < .001). At admission, significantly less Asian patients were currently taking corticosteroids, thiopurines, and biologics, and less had previous exposure to biologics ( P < .005). More Asian patients were discharged on 5-aminosalicylates ( P = .014), and fewer were prescribed corticosteroids ( P = .049), thiopurines ( P < .001), or advanced therapies ( P < .001) on discharge, but more remained corticosteroid-dependent on follow-up ( P < .029). The Asian cohort had lower rates of corticosteroid failure (21.5% vs 57.2%; P < .001), inpatient colectomy (2.8% vs 10.9%; P < .001), 1-year colectomy (4.7% vs 22.5%; P < .001), and readmission with ASUC within 12 months (9.3% vs 16.1%; P < .001), validated using a propensity score matched cohort. Conclusions The characteristics of patients with ASUC in Asia differ significantly from ANZ. Despite worse endoscopic severity and more extensive disease, the Asian ASUC cohort appears more corticosteroid-responsive with significantly lower colectomy rates and less requirement for advanced therapies.
KW - Acute Severe Ulcerative Colitis
KW - Asian
KW - Colectomy
KW - Race
KW - Western
UR - https://www.scopus.com/pages/publications/105035909228
U2 - 10.1016/j.cgh.2025.10.019
DO - 10.1016/j.cgh.2025.10.019
M3 - Article
C2 - 41173380
AN - SCOPUS:105035909228
SN - 1542-3565
VL - 24
SP - 1916
EP - 1927
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 7
ER -