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Keywords:

  • severe ulcerative colitis;
  • colectomy;
  • cyclosporin;
  • steroids

Abstract

Background: To determine the long-term outcome of patients admitted with acute severe colitis (ASC) who avoided colectomy on the index admission, a retrospective cohort study was performed.

Methods: Patients admitted for intensive treatment of ASC in 1992–1993 previously described for a predictive index of short-term outcome in severe ulcerative colitis (UC) were followed for a median 122 months (range 3–144). Complete responders (CR) to intensive therapy had <3 nonbloody stools/day on day 7 of the index admission; incomplete responders (IR) were all others who avoided colectomy on that admission. Main outcome measures were colectomy-free survival, time to colectomy, and duration of steroid-free remission.

Results: In all, 6/19 CR (32%) came to colectomy compared to 10/13 IR (P = 0.016; relative risk 3.33, 95% confidence interval [CI] 1.12–9.9). The median ± interquartile range time to colectomy was 28 ± 47 months (range 6–99) for CR who came to colectomy versus 7.5 ± 32 (3–72) months for IR (P = 0.118). Among the IR, 7/13 came to colectomy within 12 months, and all within 6 years from the index admission. The longest period of steroid-free remission was 42 ± 48 (0–120) months for CR, but 9 ± 20 (1–35) months for IR (P = 0.011).

Conclusions: One week after admission with ASC in the prebiologic era, IRs had a 50% chance of colectomy within a year and 70% within 5 years, despite cyclosporin and azathioprine where appropriate. The maximum duration of remission in CRs was almost 5 times longer than IRs. It is unknown whether biologics change the long-term outcome.

(Inflamm Bowel Dis 2009)