Long-term treatment trajectories and surgical outcomes in Chinese patients with ulcerative colitis

doi:10.3748/wjg.123418

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Jan 21, 2027; 33(3): 123418
Published online Jan 21, 2027. doi: 10.3748/wjg.123418

Long-term treatment trajectories and surgical outcomes in Chinese patients with ulcerative colitis

Wen-Jing Yang, Ling-Ya Yao, Yu-Shu Cao, Wen-Hao Xia, Xiang-Han Cao, Yi-Ning Xu, You-Jie Miao, Qian Cao

Wen-Jing Yang, Ling-Ya Yao, Yu-Shu Cao, Wen-Hao Xia, Xiang-Han Cao, Yi-Ning Xu, You-Jie Miao, Qian Cao, Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang Province, China

Author contributions: Yang WJ, Yao LY, and Cao Q contributed to the study concept and design; Yang WJ, Cao YS, Xia WH, Cao XH, Xu YN, and Miao YJ contributed to data acquisition; Yang WJ contributed to formal analysis, visualization, and manuscript drafting; Yang WJ, Yao LY, Cao YS, and Cao Q contributed to manuscript revision; and all the authors contributed to data interpretation and approved the final version of the manuscript for submission.

AI contribution statement: The authors take full responsibility and accountability for all content of this manuscript, including any portions for which AI tools were used as assistive technologies. All AI-assisted outputs were carefully reviewed, validated, and approved by the authors. AI tools were not used to generate original scientific data, perform independent scientific analyses, or draw scientific conclusions.

Supported by National Key Research and Development Program of China, No. 2023YFC2507300; National Natural Science Foundation of China, No. 82341215 and No. 82370531; and Key-Area Research and Development Program of Guangdong Province, No. 2023B1111040003.

Institutional review board statement: This study was approved by the Ethics Committee of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine (Approval No. 2025-1291).

Informed consent statement: The requirement for informed patient consent was waived given the retrospective, non-interventional study design.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Corresponding author: Qian Cao, MD, PhD, Professor, Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 East Qingchun Road, Hangzhou 310016, Zhejiang Province, China. caoq@zju.edu.cn

Received: May 18, 2026
Revised: June 13, 2026
Accepted: July 16, 2026
Published online: January 21, 2027
Processing time: 180 Days and 5.6 Hours

Abstract

BACKGROUND

The long-term influence of baseline disease activity on treatment trajectories and surgical outcomes in ulcerative colitis (UC) remains insufficiently characterized in Asian populations.

AIM

To systematically evaluate the disease course according to baseline disease activity in a well-defined cohort of Chinese patients with UC.

METHODS

Using data from the Sir Run Run Shaw Hospital IBD Biobank in China, we retrospectively enrolled patients with confirmed UC who presented between January 1999 and September 2025, with a minimum follow-up of 12 months. Disease activity at diagnosis was classified according to the Truelove and Witts criteria, with mild-to-moderate UC defined as < 6 bowel movements per day and intermittent rectal bleeding.

RESULTS

In total, 1882 patients were included (median follow-up: 6.22 years; interquartile range: 3.43–10.33), and 88.9% had mild-to-moderate disease at diagnosis. Compared with moderate-to-severe UC, those with mild-to-moderate disease were more likely to present with proctitis (36.1% vs 0.6%, excluding unknown extent; P < 0.001) and had lower rates of escalation to advanced therapies (28.0% vs 56.2%; P < 0.001) and colectomy (6.0% vs 25.0%; P < 0.001). Among patients receiving 5-aminosalicylates as first-line therapy (n = 1659), 85.2% achieved clinical response by week 4. However, delayed treatment modification (58.5%) among nonresponders (n = 246) and limited objective monitoring (week-12 colonoscopy rate: 4.6%) persisted. Treatment pathways, including the timing and sequencing of advanced therapies, varied according to baseline disease activity.

CONCLUSION

Patients with mild-to-moderate UC at diagnosis displayed distinct clinical phenotypes and generally favorable long-term outcomes. Our findings highlight the need for therapeutic optimization and improved adherence to guideline-recommended treat-to-target strategies.

Keywords: Ulcerative colitis; Disease activity; Natural history; Treatment; Chinese cohort; Treat-to-target strategies

Core Tip: In this large real-world cohort of 1882 Chinese patients with ulcerative colitis followed for a median of 6.22 years, baseline disease activity was a major determinant of treatment escalation and colectomy risk. Although most patients with mild-to-moderate disease achieved sustained control with 5-aminosalicylate, important gaps in treat-to-target care remained, including infrequent early endoscopic reassessment and delayed treatment optimization among nonresponders. These findings highlight the need for timely disease monitoring and disease activity-stratified management to improve long-term outcomes in patients with ulcerative colitis.