Our retrospective study on 240 cases with chronic ulcerative colitis in Seoul National University Hospital spanning from January, 1975 to December, 1993 revealed the following results. According to the extent of disease, there was 27.5% in
proctitis,
which was more frequent than that of the previous domestic reports, 15.8% in distal, 22.9% in left and 31.7% in extensive colitis. According to the severity of disease, there was 47.5% in mild, 32.9% in moderate and 19.6% in severe disease. There
was a
positive correlation between severity and extent of disease. The extraintestinal complications were not related with the extent or severity. However 3 cases(1.3) of toxic megacolon appeared in moderate or sever extensive colitis, one of which
progressed
to perforation. Two cases(0.8%) of mortality were noticed, one caused by perforation, the other by operation-related complication. There was not a single case of colon cancer developed luring follow-up period. Most cases showed excellent
short-term
response to medical treatment; the symptomatic remission rates were 90.3%, 85.7%, 72.9% and 58.9% in order of proctitis, distal, left and extensive colitis, and the endoscopic remission rates were 78.8%, 50.0%, 59.1% and 30.0% respectively.
Higher
remission rates corresponded with lower extent of the disease. According to the severity, the symptomatic remission rates of milder disease were significantly higher. The cumulative relapse rates were 38.7% in 1 year, 62.4% in 2 years, 73.3% in 3
years
and 81.9% in 5 years, which were not related to the extent but increased according to the severity. The cumulative operation rates were 5.0% in 1 year, 7.6% in 2 years, 10.2% in 3 years and 15.9% in 6 years. The emergency operation accounted for
only
22.2% of all operation and the others were elective ones. The most frequent indication of surgery was medical intractability which was determined after mean 35 days of intensive medical therapy. We concluded that severity and extent of ulcerative
colitis had predictive value of the responses to medical treatment or relapses, furthermore despite the high relapse rates, medical therapy was the first line treatment because of its high remission rates on a shortterm base.(Korean J
Gastroenterol
1994
; 26 : 907-918)
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