ALIMENTARY TRACT DlGE!iTLlUER 06 2001;33:606-92 Survival and causes of death in Italian patients with ulcerative colitis A GISC* nation-wide study A. Viscid0 V. Bagnardil G.C. Sturniolo2 V. Anne& G. Frieri4 A. D’Arienzo5 C. Papi G. Riegler7 G. Corraol R. Caprilli * GISC: Italian Group for the Study of the Colon and Rectum Fmm GI Unit, Department of Clinical Sciences, University “La Sapienza” of Rome; I Department of Statistics, University of Milan - “Bicocca”; * GI Unit, University of Padua; 3 GI Unit, IRCCS “Casa Sollievo de/la Sofferenza’l San Giovanni Rotondo; 4 GI Units Department of Internal Medicine, University of L Xquila; 5 GI Unit, University “Federico II” of Naples; 6 GI Unit, “San Filippo Neri” Hospital, Rome; 7 GI Unit, University “Federico II” of Naples, Italy. The following GISC investigators took part in this study: P. Paoluzi, L. Capurso, M.C. Di Paolo, V. Stiglieno, P. Fracasso 0?omel; G. Latella (L’Aquilal; M. Cottone IPalermoI; R. D’lncti, V. Di Leo [Padual; C. Del Vecchio Blanc0 [NaplesI; G. Ciancio (Florancel; M. lngrosso IBaril; V. Ponti [Turin); C. Mansi (Genoa); D. Valpiani (Forlil: G.P. Rigo (Modenal; G.P. Bresci (Pisal; A. Tragnone IBolognal. M&es8 hw comepoehece Dr. A. Viscido, Dipartimento di Science Cliniche, Cattedra di Gastroenterologia, Universith “La Sapienze” di Roma, Policlinico “Umberto I”, viale del Policlinico, 155, 00161 Roma, Italy. Fax: +39-06-4463737. E-mail: angviscido@yahoo.it Submitted February 19, 2001. Accepted after revision July 5, 2001. Background. Death rate for patients with ulcerative colitis has changed over last few decades. Recent studies indicate that cumulative long- term mortality is comparable to that in general population, and that deaths may depend on causes not strictly related to colonic disease. Aim. To evaluate overall and cause-specific mortality rate in a large group of Italian patients with ulcerative colitis. Methods. A total of 2,066 ulcerative colitis patients aged > 7 8 years consecutively diagnosed in twenty Italian Gastroenterology Units between 1964 and 1995 were followed-up from diagnosis until 1997. Standard- ised Mortality Ratios and Relative Survival Ratios were calculated. Results. Overall mortality of patients with ulcerative colitis was com- parable to that in general population with 93 deaths observed versus 92. I expected [standardises mortality ratio, I. 0; 95% confidence in- terval, 0.8- 1.2). Significantly higher mortality was observed in patients under 30 years of age at diagnosis [standardised mortality ratio, 2.7; 95% confidence interval, 1.3-4.91, and in those diagnosed before 1974 [standardised mortality ratio, 2.7; 95% confidence interval, I. I-5.71. Proctocolitis and complications from surgery were men- tioned in 1 I and 5 certificates, respectively A significant excess of deaths was observed for colorectal cancer [colon: standardised mor- tality ratio, 3.0; 95% confidence interval, I. O-6.9; rectum: standard- ised mortality ratio, 4.4; 95% confidence interval, I .2- I I. 3), and haemolymphopoietic neoplasms [standardised mortality ratio, 2.8; 95% confidence interval, I. O-6. I], in particular multiple myeloma and non-Hodgkin lymphoma. A significant deficit of deaths was observed for cancer of the respiratory system [standardised mortality ratio, 0.3; 95% confidence interval, 0. I- I. 01. Conclusions. This study confirms that, also in ItaIM mortality of pa- tients with ulcerative colitis is comparable to that in general population. Only 12% of deaths were due to ulcerative colitis itself, whereas 10% of deaths were attributed to colorectal cancer. Deaths from colorectal cancer occurred, on average, 9 years after diagnosis of ulcerative col- itis, suggesting that the risk of cancer is not limited to patients with long-standing colitis. As to mortality for causes unrelated to colitis, there was an excess of deaths due to malignancies of the haemolym- phopoietic system. Digest Liver Dis 2001;33:686-92 Key words: ulcerative colitis mortality Introduction Ulcerative colitis (UC) is an idiopathic inflammatory bowel disease (IBD) characterised by colonic mucosal inflammation and a chronic relapsing