Copyright
©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Incidence, disease course, therapeutic strategies and outcomes of inflammatory bowel disease-unclassified patients in Western Hungary: A population-based cohort
Fruzsina Balogh, Lorant Gonczi, Dorottya Angyal, Petra Anna Golovics, Tunde Pandur, Gyula David, Zsuzsanna Erdelyi, Istvan Szita, Akos Ilias, Laszlo Lakatos, Peter Laszlo Lakatos
Fruzsina Balogh, Petra Anna Golovics, Department of Gastroenterology, Central Hospital of Northern Pest-Military Hospital, Budapest 1062, Hungary
Fruzsina Balogh, Peter Laszlo Lakatos, Department of Internal Medicine and Oncology, Semmelweis University, Budapest 1083, Hungary
Lorant Gonczi, Dorottya Angyal, The First Department of Medicine, Semmelweis University, Budapest H-1083, Hungary
Tunde Pandur, Department of Gastroenterology, Grof Eszterhazy Hospital, Pápa 8500, Hungary
Gyula David, Zsuzsanna Erdelyi, Istvan Szita, Laszlo Lakatos, Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem 8200, Hungary
Akos Ilias, Department of Internal Medicine and Oncology, Semmelweis University, Budapest H-1083, Hungary
Peter Laszlo Lakatos, Division of Gastroenterology & Hepatology, McGill University, Montreal H3A0G4, Quebec, Canada
Co-first authors: Fruzsina Balogh and Lorant Gonczi.
Author contributions: Balogh F and Gonczi L were responsible for study design, data analysis and manuscript drafting; Lakatos L was responsible for patient enrollment, data collection, supervising the collection and validation of patients, database construction, manuscript revision; Angyal D, Golovics PA, Ilias A, Pandur T, David G, Erdelyi Z and Szita I were responsible for patient enrollment and data collection and manuscript revision. Language editing was performed by a native English-speaker. Lakatos PL was responsible for study design, research planning data collection, supervising the collection and validation of patients, database construction, and result interpretation, data analysis and statistical calculations and supervised the manuscript preparation. Lakatos PL is acting as guarantor of the submission. All authors approved the final manuscript.
Institutional review board statement: The study was approved by the Csolnoky F. Province Hospital Institutional Committee of Science and Research Ethics (193/2004, 0712/2009, and 2/2021).
Informed consent statement: Patients were not required to give informed consent for the study as the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Peter Laszlo Lakatos, PhD, Professor, Division of Gastroenterology & Hepatology, McGill University, 1650 Avenue Cedar, Montreal H3A0G4, Quebec, Canada.
kislakpet99@gmail.com
Received: May 23, 2025
Revised: June 8, 2025
Accepted: August 4, 2025
Published online: September 7, 2025
Processing time: 101 Days and 18 Hours
BACKGROUND
The number of population-based studies on unclassified inflammatory bowel disease (IBD-U) is very limited.
AIM
To evaluate the long-term incidence, disease course and surgery rates of IBD-U in a prospective population-based cohort.
METHODS
The present study is a continuation of the well-established Veszprem IBD cohort with patient inclusion between 1977 and 2018. Both in-hospital and outpatient records were collected. The source of age- and gender-specific demographic data was derived from the Hungarian Central Statistical Office. Medical therapy, surgery and change in disease phenotype were analyzed.
RESULTS
Data of 119 incident IBD-U patients were analyzed [male/female: 55/64; median age at diagnosis: 34 years (interquartile range: 24-47.5)]. Adjusted mean incidence rate was 0.76 (95%CI: 0.63-0.9)/105 person-years in the total study period. Disease extent at diagnosis was extensive (pancolitis) in 56.3%. Twenty-two of 119 (18.5%) patients were reclassified to Crohn’s disease during follow up, the probability of developing terminal ileum involvement was 6.8%, while perianal disease developed in 5% (n = 6). The probability of receiving biological therapy in patients diagnosed after the year 2000 (n = 62), was 15.5% (SD: 4.8) at 5 years. The overall resective surgery rate was 16.8%. Segment resection was performed in 5.0% of the patients, and 11.8% underwent subtotal or total colectomy. The cumulative probability of resective surgery was 7.6% (SD: 2.4) at 1 year, 9.3% (SD: 2.7) at 5 years, 13.5% (SD: 3.3) at 10 years, and 18.5% (SD: 3.9) at 20 years.
CONCLUSION
These data extend our knowledge on the overall burden of IBD-U. Colonic involvement was extensive in a high proportion of IBD-U. Disease reclassification to Crohn’s disease was relatively high. High rates of biological therapy and surgery rates support a relatively severe disease course of IBD-U.
Core Tip: This is the one of the first comprehensive, population-based study from Eastern Europe evaluating the long-term incidence, disease progression, and outcomes of unclassified inflammatory bowel disease (IBD-U). Analyzing data from 119 patients over four decades, we identified a high rate of reclassification to Crohn’s disease and substantial use of biological therapies and surgeries, reflecting a more severe disease phenotype than previously reported. These findings challenge the notion of IBD-U as a benign or transitional diagnosis and underscore the need for tailored therapeutic strategies and further longitudinal research.
