Clinical features and biomarkers associated with ulcerative colitis: A systematic review and meta-analysis

doi:10.3748/wjg.123374

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World Journal of Gastroenterology

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1007-9327

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Meta-Analysis

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. Dec 14, 2026; 32(46): 123374
Published online Dec 14, 2026. doi: 10.3748/wjg.123374

Table 1 Baseline characteristics and geographical distribution of the included studies

Diseases	Continent
Diseases	North America	Asia	Oceania	Africa	South America	Europe	Total
UC	6457	71488	19	6	161	40218	118349
ITB	0	394	0	0	0	0	394
IBS	0	319	0	0	0	0	319
IE	0	247	0	0	0	0	247
HCs	40147	7664	0	0	60	69892	117763
CD	8772	28984	41	9	111	22724	60641
IC	0	602	0	0	0	0	602
IBD-U	38	208	0	0	5	338	589
Other	156	2347	0	0	0	13	2516
Total	55570	112253	60	15	337	133185	301420

UC: Ulcerative colitis; ITB: Intestinal tuberculosis; IBS: Irritable bowel syndrome; IE: Infectious enteritis; HCs: Healthy controls; CD: Crohn’s disease; IC: Ischemic colitis; IBD-U: Inflammatory bowel disease unclassified; Other: Unspecified diseases.

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Table 2 Meta-analysis of gastrointestinal manifestations in ulcerative colitis vs controls

	Number of studies	OR (95%CI)	I² value
Diarrhea
UC compared to CD	90	2.8354 (2.1042-3.8207)	91.90%
UC compared to IC	20	3.6189 (1.9834-6.6029)	79.20%
UC compared to ITB	7	3.2938 (1.4310-7.5817)	61.40%
UC compared to IBS	1	0.8547 (0.2845-2.5672)	Ne
UC compared to IE	1	73.125 (12.0141-445.0822)	Ne
UC compared to IBD-U	8	0.7829 (0.3692-1.6600)	65.50%
UC compared to other	8	3.7437 (1.5344-9.1339)	75.30%
Abdominal pain
UC compared to CD	97	0.6813 (0.5385-0.8620)	82.20%
UC compared to IC	20	0.7049 (0.3922-1.2671)	68.80%
UC compared to ITB	7	0.3951 (0.2311-0.6755)	20.20%
UC compared to IBS	1	0.2553 (0.0657-0.9921)	Ne
UC compared to IE	2	0.8325 (0.1465-4.7294)	82.70%
UC compared to IBD-U	8	1.4172 (0.5101-3.9370)	79.30%
UC compared to other	8	0.8051 (0.3394-1.9100)	74.10%
Abdominal distension
UC compared to CD	24	0.6236 (0.4878-0.7972)	44.00%
UC compared to IC	8	0.5393 (0.1809-1.6077)	59.40%
UC compared to ITB	2	0.3423 (0.0903-1.2975)	52.70%
UC compared to IBS	1	0.0981 (0.0377-0.2553)	Ne
UC compared to IBD-U	3	0.5682 (0.2499-1.2918)	0.00%
UC compared to other	4	0.8627 (0.1881-3.9578)	80.30%
Abdominal masses
UC compared to CD	31	0.1156 (0.0567-0.2359)	62.60%
UC compared to ITB	2	0.0877 (0.0148-0.5177)	0.00%
UC compared to other	2	0.0204 (0.0025-0.1695)	0.00%
Constipation
UC compared to CD	13	0.7023 (0.4373-1.1278)	1.80%
UC compared to IC	1	0.0462 (0.0026-0.8288)	Ne
UC compared to IBD-U	2	1.6415 (0.3023-8.9145)	0.00%
UC compared to other	1	1.0548 (0.5142-2.1637)	Ne
Hematochezia
UC compared to CD	67	4.972 (3.2464-7.6149)	86.00%
UC compared to IC	20	0.2188 (0.0928-0.5157)	89.10%
UC compared to ITB	4	14.6073 (1.7111-124.7033)	84.30%
UC compared to IBS	1	1.6536 (0.7376-3.7070)	Ne
UC compared to IE	1	15.9107 (7.8763-32.1409)	Ne
UC compared to IBD-U	7	1.3433 (0.3460-5.2160)	62.90%
UC compared to other	5	10.0202 (1.9272-52.0994)	84.50%
Mucous stools
UC compared to CD	15	3.8432 (2.3049-6.4084)	74.00%
UC compared to IC	3	16.0749 (2.9795-86.7264)	0.00%
UC compared to IBS	1	0.2935 (0.1207-0.7136)	Ne
UC compared to IE	1	1.5467 (0.8513-2.8101)	Ne
UC compared to IBD-U	2	0.2084 (0.0033-13.0778)	79.00%
UC compared to other	1	5.3478 (2.1506-13.2983)	Ne
Bloody mucopurulent stools
UC compared to CD	32	13.3297 (8.2855-21.4449)	77.20%
UC compared to IC	14	20.6811 (10.9195-39.1691)	29.10%
UC compared to ITB	2	43.1424 (5.7461-323.9189)	0.00%
UC compared to IBD-U	3	0.6677 (0.1310-3.4033)	82.90%
UC compared to other	2	6.1153 (0.3181-117.5773)	72.50%
Tenesmus
UC compared to CD	35	3.7201 (2.7546-5.0238)	54.30%
UC compared to IC	10	11.5292 (4.4590-29.8098)	13.00%
UC compared to ITB	1	6.1268 (0.9247-40.5953)	Ne
UC compared to IBS	1	0.1722 (0.0732-0.4049)	Ne
UC compared to IE	1	1.6101 (0.9868-2.6270)	Ne
UC compared to IBD-U	2	0.8719 (0.4974-1.5284)	0.00%
UC compared to other	1	1.5726 (0.6142-4.0266)	Ne
Perianal fistulae
UC compared to CD	16	0.0769 (0.0438-0.1350)	25.20%
Perianal abscesses
UC compared to CD	22	0.1328 (0.0555-0.3177)	69.70%
UC compared to IBD-U	1	0.36 (0.0826-1.5684)	Ne
UGI symptoms
UC compared to CD	20	0.5823 (0.3765-0.9004)	66.80%
UC compared to IC	7	0.5417 (0.2933-1.0007)	0.00%
UC compared to IE	1	0.0344 (0.0149-0.0791)	Ne
UC compared to IBD-U	2	0.3599 (0.1611-0.8042)	0.00%
UC compared to other	2	0.6508 (0.3637-1.1643)	0.00%

UC: Ulcerative colitis; CD: Crohn’s disease; IC: Ischemic colitis; ITB: Intestinal tuberculosis; IBS: Irritable bowel syndrome; IE: Infectious enteritis; IBD-U: Inflammatory bowel disease unclassified; Other: Unspecified diseases; OR: Odds ratios; CI: Confidence intervals; UGI: Upper gastrointestinal; Ne: There is only one type of disease in the control group, or only a single study was included, precluding the assessment of heterogeneity.

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Table 3 Meta-analysis of extraintestinal manifestations in ulcerative colitis vs controls

	Number of studies	OR (95%CI)	I² value
Overall EIMs
UC compared to CD	37	0.4676 (0.3596-0.6081)	90.00%
UC compared to IC	1	22.8806 (1.2901-405.7843)	Ne
UC compared to ITB	1	2.9765 (1.9716-4.4936)	Ne
Arthritis
UC compared to CD	83	0.6018 (0.5059-0.7159)	86.70%
UC compared to IC	3	1.0689 (0.1786-6.3983)	0.00%
UC compared to ITB	2	1.9731 (0.3509-11.0959)	44.30%
UC compared to IBD-U	5	0.552 (0.2304-1.3225)	67.10%
UC compared to other	2	0.4221 (0.0378-4.7080)	86.50%
UC compared to HCs	5	2.7051 (1.6184-4.5214)	96.80%
Oral lesions
UC compared to CD	51	0.3176 (0.2285-0.4414)	61.80%
UC compared to IC	2	2.1854 (0.0611-78.1549)	63.10%
UC compared to ITB	2	0.3614 (0.0125-10.4663)	80.90%
UC compared to IBD-U	5	0.5973 (0.2640-1.3518)	15.20%
UC compared to other	1	0.0029 (0.0003-0.0243)	Ne
UC compared to HCs	1	15.7109 (0.8862-278.5145)	Ne
Dermatological manifestations
UC compared to CD	72	0.5394 (0.4539-0.6411)	56.40%
UC compared to ITB	1	2.4982 (0.3267-19.1032)	Ne
UC compared to IBD-U	3	0.1441 (0.0783-0.2652)	63.80%
UC compared to other	1	0.0089 (0.0005-0.1678)	Ne
UC compared to HCs	5	1.9999 (1.4759-2.7101)	61.40%
Ocular involvement
UC compared to CD	45	0.6127 (0.4712-0.7968)	57.90%
UC compared to IC	1	2.5765 (0.1018-65.1991)	Ne
UC compared to ITB	1	2.333 (0.5494-9.9066)	Ne
UC compared to IBD-U	2	1.758 (0.2898-10.6648)	0.00%
UC compared to HCs	1	2.3863 (1.9858-2.8676)	Ne
Hepatobiliary involvement
UC compared to CD	44	1.2127 (0.8564-1.7171)	82.20%
UC compared to ITB	1	1.961 (0.1080-35.6005)	Ne
UC compared to IBD-U	2	1.5412 (0.8790-2.7021)	0.00%
UC compared to other	1	1.5086 (0.1948-11.6805)	Ne
UC compared to HCs	3	5.2312 (0.6907-39.6177)	98.60%

UC: Ulcerative colitis; CD: Crohn’s disease; IC: Ischemic colitis; ITB: Intestinal tuberculosis; OR: Odds ratios; CI: Confidence intervals; IBD-U: Inflammatory bowel disease unclassified; Other: Unspecified diseases; HCs: Healthy controls; EIMs: Extraintestinal manifestations; Ne: There is only one type of disease in the control group, or only a single study was included, precluding the assessment of heterogeneity.

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Table 4 Meta-analysis of systemic signs in ulcerative colitis vs controls

	Number of studies	OR (95%CI)	I² value
Anemia
UC compared to CD	45	0.5845 (0.4900-0.6973)	69.80%
UC compared to ITB	1	0.24 (0.0683-0.8433)	Ne
UC compared to IBD-U	4	1.3163 (0.8129-2.1316)	35.30%
UC compared to other	2	0.6 (0.2548-1.4129)	0.00%
Fatigue
UC compared to CD	12	0.8994 (0.5129-1.5773)	78.80%
UC compared to IC	1	0.5496 (0.0255-11.8444)	Ne
UC compared to ITB	2	0.34 (0.1144-1.0105)	0.00%
UC compared to IBD-U	2	0.5497 (0.2986-1.0119)	0.00%
UC compared to other	2	0.7448 (0.4435-1.2509)	0.00%
Fever
UC compared to CD	67	0.6065 (0.5041-0.7297)	63.90%
UC compared to IC	11	0.7294 (0.4197-1.2676)	22.70%
UC compared to ITB	7	0.2282 (0.0852-0.6110)	73.00%
UC compared to IE	1	83.8148 (4.6836-1499.8891)	Ne
UC compared to IBD-U	6	1.0947 (0.6892-1.7388)	0.00%
UC compared to other	5	0.9187 (0.2980-2.8329)	57.40%
Weight loss
UC compared to CD	57	0.4922 (0.4076-0.5943)	71.40%
UC compared to IC	1	8 (3.0025-21.3153)	Ne
UC compared to ITB	3	0.3211 (0.0706-1.4613)	69.40%
UC compared to IBD-U	5	1.4825 (0.8605-2.5540)	0.00%
UC compared to Other	4	1.0331 (0.4837-2.2067)	0.00%

UC: Ulcerative colitis; CD: Crohn’s disease; IC: Ischemic colitis; ITB: Intestinal tuberculosis; OR: Odds ratios; CI: Confidence intervals; IE: Infectious enteritis; IBD-U: Inflammatory bowel disease unclassified; Other: Unspecified diseases; Ne: There is only one type of disease in the control group, or only a single study was included, precluding the assessment of heterogeneity.

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Table 5 Meta-analysis of biomarkers in ulcerative colitis vs controls

	Number of studies	Effect size (95%CI)	I² value
FC positivity (OR)
UC compared to CD	10	0.8029 (0.3844-1.6770)	75.20%
UC compared to IBS	1	10.0918 (3.5706-28.5235)	Ne
UC compared to IBD-U	2	0.5636 (0.0665-4.7739)	0.00%
UC compared to other	4	12.7445 (6.7843-23.9407)	0.00%
UC compared to HCs	4	285.5777 (68.7070-1186.9908)	0.00%
FC levels (MD)
UC compared to CD	24	-10.6616 (-66.3126 to 44.9894)	97.70%
UC compared to IBS	5	696.306 (512.3838-880.2281)	99.00%
UC compared to other	3	120.338 (-70.7491 to 311.4251)	89.20%
UC compared to HCs	26	426.2342 (335.0397-517.4287)	100.00%
p-ANCA positivity (OR)
UC compared to CD	47	8.7037 (6.6969-11.3119)	53.30%
UC compared to IC	1	4.0000 (0.9281-17.2388)	Ne
UC compared to ITB	2	15.8809 (3.8349-65.7653)	0.00%
UC compared to IBS	1	23.5926 (1.2322-451.7344)	Ne
UC compared to IE	2	28.3675 (3.6668-219.4573)	0.00%
UC compared to IBD-U	3	26.5096 (7.3220-95.9795)	38.90%
UC compared to other	25	21.7577 (14.9375-31.6918)	39.90%
UC compared to HCs	28	41.5012 (25.1279-68.5433)	34.20%
p-ANCA levels (MD)
UC compared to CD	2	27.7359 (14.6785-40.7934)	80.00%
UC compared to other	2	28.8051 (17.2770-40.3332)	74.90%
UC compared to HCs	2	35.2552 (9.7248-60.7855)	95.10%
ESR positivity (OR)
UC compared to CD	16	0.5707 (0.4029-0.8084)	29.40%
UC compared to ITB	3	0.6025 (0.3372-1.0764)	0.00%
UC compared to IE	1	37.8889 (2.1467-668.7448)	Ne
UC compared to IBD-U	1	3.6000 (0.8636-15.0076)	Ne
UC compared to other	1	0.9327 (0.4731-1.8387)	Ne
ESR levels (MD)
UC compared to CD	40	-2.8644 (-4.9876 to -0.7413)	75.80%
UC compared to IC	1	12.53 (0.4956-24.5644)	Ne
UC compared to IBS	3	10.881 (5.3579-16.4042)	98.90%
UC compared to IE	1	6.4000 (3.5673-9.2327)	Ne
UC compared to other	4	14.1143 (9.0235-19.2051)	97.40%
UC compared to HCs	46	17.5460 (14.2601-20.8319)	99.50%
CRP positivity (OR)
UC compared to CD	25	0.7290 (0.5448-0.9754)	51.70%
UC compared to ITB	4	1.0034 (0.5722-1.7593)	0.00%
UC compared to IBS	1	4.8125 (0.8807-26.2985)	Ne
UC compared to IE	1	22.4545 (4.3865-114.9443)	Ne
UC compared to IBD-U	1	1.3077 (0.3115-5.4896)	Ne
UC compared to other	2	1.0133 (0.5217-1.9680)	0.00%
UC compared to HCs	2	34.2172 (4.5295-258.4887)	0.00%
CRP levels (MD)
UC compared to CD	36	-3.7779 (-6.0523 to -1.5034)	93.00%
UC compared to IC	1	-23.2300 (-26.4149 to -20.0451)	Ne
UC compared to IBS	3	13.8121 (6.6713-20.9528)	99.00%
UC compared to IE	1	10.8 (8.7659-12.8341)	Ne
UC compared to IBD-U	1	6.71 (5.9886-7.4314)	Ne
UC compared to other	5	5.16 (2.2605-8.0596)	98.60%
UC compared to HCs	81	15.126 (12.1893-18.0627)	99.90%

OR: Odds ratios; CI: Confidence intervals; MD: Mean differences; UC: Ulcerative colitis; CD: Crohn’s disease; IC: Ischemic colitis; IBD-U: Inflammatory bowel disease unclassified; IE: Infectious enteritis; ITB: Intestinal tuberculosis; IBS: Irritable bowel syndrome; HCs: Healthy controls; Other: Unspecified diseases; FC: Fecal calprotectin; p-ANCA: Perinuclear anti-neutrophil cytoplasmic antibodies; ESR: Erythrocyte sedimentation rate; CRP: C-reactive protein; Ne: There is only one type of disease in the control group, or only a single study was included, precluding the assessment of heterogeneity.

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Table 6 Meta-analysis of inflammatory markers in active ulcerative colitis compared with clinical remission and healthy controls

	Number of studies	MD (95%CI)	I² value
FC levels
Active UC vs CR	24	387.04 (292.55-481.54)	99.90%
Active UC vs HCs	11	486.94 (371.31-602.58)	99.70%
ESR levels
Active UC vs CR	42	14.33 (11.93-16.73)	98.70%
Active UC vs HCs	24	17.40 (13.42-21.38)	99.50%
CRP levels
Active UC vs CR	67	12.94 (10.48-15.41)	99.40%
Active UC vs HCs	38	16.81 (12.67-20.95)	99.90%

MD: Mean difference; CI: Confidence interval; UC: Ulcerative colitis; FC: Fecal calprotectin; CR: Clinical remission; HCs: Healthy controls; ESR: Erythrocyte sedimentation rate; CRP: C-reactive protein.

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Citation: Liu K, Zhang XH, Zhou XY, Liu YX, Pan SQ, Liu TX, Russell R, Wang XH, Yao YP, Zhao XJ, Sun HY, Ju CL, Liu JP, Liu ZL. Clinical features and biomarkers associated with ulcerative colitis: A systematic review and meta-analysis. World J Gastroenterol 2026; 32(46): 123374
URL: https://www.wjgnet.com/1007-9327/full/v32/i46/123374.htm
DOI: https://dx.doi.org/10.3748/wjg.123374

Liu K, Zhang XH, Zhou XY, Liu YX, Pan SQ, Liu TX, Russell R, Wang XH, Yao YP, Zhao XJ, Sun HY, Ju CL, Liu JP, Liu ZL. Clinical features and biomarkers associated with ulcerative colitis: A systematic review and meta-analysis. World J Gastroenterol 2026; 32(46): 123374 [DOI: 10.3748/wjg.123374]

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