Intestinal complications in Brazilian patients with ulcerative colitis treated with conventional therapy between 2011 and 2020

Table 1 Description of most common intestinal complications related to associated diseases (International Statistical Classification of Diseases and Related Health Problems) or procedures (codes), n (%)

ICs	Description of ICs	Patients (n = 1273)	%	Procedure-related complications		Patients (n = 1125)	%
Associated disease (ICD-10–related complications)				0407020403	Abdominal rectosigmoidectomy	167	15
K62	Other diseases of the anus and rectum	1070	78	0407020390	Body removed – rectum or colon polyps	145	13
C18	Malignant neoplasms of the colon	255	19	0407020063	Partial colectomy	135	12
K59	Other functional intestinal disorders	66	5	0407020209	Enteroctomy and/or resection	128	11
L52	Erythema nodosum	27	2	0407020101	Colostomy	105	9
K56	Paralytic ileus and intestinal obstruction without hernia	3	0.2	0407020128	Dilatation of the anus and/or rectum	91	8
K51	Ulcerative colitis	2	0.1	0407020098	Abdominal colporrhaphy	51	5
C63	Malignant neoplasms of other and unspecified male genital organs	1	0.1	0407020241	Enterostomy closure	50	4
				0407020187	Enteroanastomy	41	4

Enterotomy is surgical incision into the intestine. ICs: intestinal complications; ICD: International Classification of Diseases.

Table 2 Demographic characteristics and follow-up of patients with ulcerative colitis treated with conventional therapies, n (%)

Variable	n	%
Patients	41229	100
Age1, yr
mean ± SD	48.86 ± 15.42
Median (IQI)	48.09 (60.15-36.94)
Sex
Male	14417	35
Female	26812	65
Ethnicity
White	23290	56
Black and other	11987	33
Missing	4643	11
CVT initiation
2011	4300	10
2012	4054	10
2013	4259	10
2014	4877	12
2015	4846	12
2016	5039	12
2017	5565	13
2018	5040	12
2019	3249	8
Follow-up time2, yr
mean ± SD	3.65 (2.27)
Median (IQI)	3.25 (1.75-5.26)
Region of residence
Southeast	22942	56
South	8831	21
Midwest	2638	6
Northeast	5833	14
North	985	2
Missing	0	0
Patients under CVT
Mesalazine	35923	87
Sulfasalazine	6148	15
Azathioprine	6413	16
Ciclosporine	116	0
Methotrexate	290	1
Time using CVT3, yr
mean ± SD	2.64 (2.29)
Median (IQI)	1.92 (0.75-4.00)
Patients switched treatment after first IC4	2564	6
Time to switch treatment after IC, yr
mean ± SD	0.36 (0.76)
Median (IQI)	0.08 (0.08-0.25)
Min	0.08

Values are expressed as numbers (%) or medians (range).

¹Age at index date.

²Time since index date up to the last date of patient information available in the database.

³Calculated based on the index date and the last claim of conventional therapy.

⁴Switching from one conventional therapy to another conventional therapy.

CVT: Conventional therapy; IQI: Interquartile interval; UC: Ulcerative colitis.

Table 3 Incidence of intestinal complications (overall and segregated types) in patients with ulcerative colitis considering all population at risk

	Total of events	First event1 (n)	PY2	IR (95%CI)
Overall	6711	3616	141997.40	2.546 (2.464-2.628)
Associated disease (ICD-10-related)	3766	1372	146806.44	0.934 (0.885-0.983)
Procedure-related	1324	1125	148326.75	0.758 (0.714-0.802)
Colitis-related Hospitalization	1791	1426	147412.62	0.967 (0.917-1.017)

Incidence rate = n of patients with event/patient year × 100.

¹Counted only the first intestinal complication (claim), but the patient could present with more than one IC (represented by the sum of the first claim).

²Patient year = sum of time of all patients under risk, since index date up to first IC or last available data.

ICs: Intestinal complications; IR: Incidence rate; ICD: International Classification of Diseases; PY: Patient year; UC: Ulcerative colitis.

Table 4 Annual incidence of intestinal complications (overall and segregated type) in patients with ulcerative colitis over the study period (January 2011-February 2020)

	Overall				Associated disease (ICD-10–related)				Procedure-related				UC-related hospitalization
	Patients (n)	%	Claims (n)	mean ± SD	Patients (n)	%	Claims (n)	mean ± SD	Patients (n)	%	Claims (n)	mean ± SD	Patients (n)	%	Claims (n)	mean ± SD
≤ 1 yr (n = 41229)	1197	2.90	1582	1.32 ± 1.3	487	1.18	763	1.57 ± 1.92	293	0.71	312	1.06 ± 0.29	456	1.10	520	1.14 ± 0.44
2 yr (n = 36389)	931	2.56	1250	1.34 ± 1.35	355	0.98	601	1.69 ± 2.08	262	0.72	284	1.08 ± 0.36	343	0.94	376	1.1 ± 0.32
3 yr (n = 28795)	716	2.49	953	1.33 ± 1.39	305	1.06	493	1.62 ± 2.05	182	0.63	201	1.1 ± 0.34	242	0.84	263	1.09 ± 0.34
4 yr (n = 22012)	531	2.41	668	1.26 ± 1.16	219	0.99	323	1.47 ± 1.72	158	0.72	170	1.08 ± 0.37	163	0.74	177	1.09 ± 0.32
5 yr (n = 16510)	389	2.36	457	1.17 ± 0.88	146	0.88	190	1.3 ± 1.36	113	0.68	115	1.02 ± 0.13	139	0.84	155	1.12 ± 0.36

n of patients: Counted only the number of patients with intestinal complications (ICs) (first IC), but patients could present with more than one IC. n of claims: Counted the total number of claims. ICs: Intestinal complications; ICD: International Classification of Diseases; IR: Incidence rate; UC: Ulcerative colitis.

Table 5 Length of hospitalization and most common procedures performed during hospitalization

Length of hospitalization and procedures	mean ± SD	Median (IQI)	Procedures (inpatient most common procedures1)		Patients (n = 1426)	%
			ICs	Description of ICs
Hospitalization (inpatient)			303070099	Treatment of enteritis and colitis not infectious	1103	77
Length of hospital stay, d (PPPY)	6.62 ± 6.62	4.60 (2.63-8.11)	301060088	Diagnose and/or emergence care in medical clinic	102	7
Number of procedures performed (PPPY)	0.32 ± 0.28	0.23 (0.15-0.38)	303070110	Treatment of other intestinal diseases	56	4
			301060070	Diagnosis and/or emergence care in surgery clinic	47	3
		415010012	Treatment with multiple surgeries	44	3
		415020034	Other procedures with following surgeries	30	2
		407020071	Total colectomy	29	2
		303070102	Treatment of digestive tract disease	23	2
		407020330	Total proctocolectomy	12	1
		303010061	Exploratory laparotomy	9	1

¹Inpatient procedures reported with ulcerative colitis disease International Statistical Classification of Diseases and Related Health Problems codes.

ICs: Intestinal complications; ICD: International Classification of Diseases; IQI: Interquartile interval; PPPY: Per patient per year; UC: Ulcerative colitis.