S2018 Clinical Evolution, Complications, and Need for Advanced Therapy in Patients With Ulcerative Colitis: Experience of an Institutional Cohort in Colombia

Introduction: Ulcerative colitis (UC) is a chronic inflammatory disorder with variable clinical trajectories. While disease extension and severity influence outcomes, regional data on complication timing and predictors in Latin America are limited. We aimed to describe the clinical course of UC, focusing on time to major complications and impact of advanced therapies in a Colombian cohort. Methods: We conducted a retrospective cohort study of 53 adult patients with UC followed at a tertiary care center in Colombia. Demographic, clinical, and therapeutic data were extracted from medical records. Outcomes included intestinal (bleeding, strictures, pseudopolyps, surgery) and extraintestinal complications (osteoporosis, primary sclerosing cholangitis (PSC), uveitis, spondyloarthropathies), timing of onset, and use of immunomodulators or biologics. Statistical comparisons explored associations with sex, disease extent, and treatment refractoriness. Results: Fifty-three patients were included (39.6% men, 60.4% women). Disease location was proctitis in 38.1%, left-sided colitis in 23.8%, and pancolitis in 30.2%. Intestinal complications occurred in 28.3%, with bleeding requiring hospitalization in 18.9%. Other events included abscesses (5%) and one obstruction; no perforations, megacolon, or fistulas. Extraintestinal manifestations were observed in 15.1%; 5% developed PSC, 7% osteoporosis, and 6% spondyloarthropathies. One patient had uveitis and one thromboembolic disease. No dermatologic manifestations were observed. Surgery was required in 9.4%. Mean time to hemorrhage requiring hospitalization was 51 months. Advanced therapies were started at 46 months. Among refractory patients, vedolizumab was used in 50% and tofacitinib in 33%; only one discontinued due to adverse events. Patients on biologics had fewer intestinal complications (18.8% vs 30.6%, P = 0.2). Female patients had a higher complication rate (34% vs 19%, P = 0.1). All surgical patients had disease extending beyond the rectum. No association was found between timing of biologic initiation and surgery or complications. Conclusion: In this UC cohort, extraintestinal manifestations and need for advanced therapies emerged after several years. While biologics did not significantly alter complication rates, all patients requiring surgery had extensive disease. This study adds real-world evidence from Latin America, an underrepresented region in IBD research, highlighting the need to expand studies in diverse populations to inform context-relevant care.