| Colectomy rate in acute severe ulcerative colitis in the infliximab era. | |
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MedLine Citation:
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PMID: 18472316 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Severe ulcerative colitis is a potentially life-threatening condition. Due to advances in medical therapy, the mortality rate has dropped to <2% over the past 30 years, but the colectomy rate reaches 30%. Recently, infliximab has been shown to be effective as rescue therapy but little is known about long-term benefits. AIM: To evaluate short-and long-term colectomy rates for severe ulcerative colitis in the era of biological treatment and to identify predictive factors of long-term colectomy. PATIENTS AND METHODS: From 2001 to 2006 all in-patients with severe ulcerative colitis, according to Truelove and Witts criteria, were retrospectively reviewed. All patients had received intravenous steroid treatment; infliximab (5 mg/kg at 0, 2 and 6 weeks) was used as rescue therapy in steroid-refractory patients; colectomy was performed in patients who deteriorated whilst on steroid treatment or failed to respond to infliximab. RESULTS: Of the 314 ulcerative colitis patients hospitalized during the study period, 52 (16.5%) met the criteria of severe ulcerative colitis. After median 7 days (range 4-15) on intravenous steroids, 37/52 (71%) patients showed a clinical response, while 15/52 (29%) were steroid-refractory. Of these, four underwent urgent colectomy and 11 received infliximab. A clinical response was observed in all infliximab-treated patients. In the long-term, another six patients underwent elective colectomy. The overall colectomy rate, following the acute attack, was 19%; the cumulative probability of a course without colectomy was 90%, 86%, 84%, 81%, after 6, 12, 18 and 24 months, respectively. No deaths occurred. The long-term colectomy risk was comparable in patients treated with infliximab and in steroid-responsive patients (18% vs. 11% respectively; OR 1.9; 95% CI 0.26-14.5). No predictive factors of colectomy, in the long-term, were identified. CONCLUSIONS: Surgery continues to play an important role in acute severe ulcerative colitis. Infliximab can avoid urgent colectomy in steroid-refractory patients but the risk of elective colectomy, in the long-term, is not modified. |
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Authors:
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A Aratari; C Papi; V Clemente; A Moretti; R Luchetti; M Koch; L Capurso; R Caprilli |
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Publication Detail:
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Type: Journal Article Date: 2008-05-09 |
Journal Detail:
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Title: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver Volume: 40 ISSN: 1878-3562 ISO Abbreviation: Dig Liver Dis Publication Date: 2008 Oct |
Date Detail:
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Created Date: 2008-08-18 Completed Date: 2008-09-18 Revised Date: 2009-05-20 |
Medline Journal Info:
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Nlm Unique ID: 100958385 Medline TA: Dig Liver Dis Country: Netherlands |
Other Details:
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Languages: eng Pagination: 821-6 Citation Subset: IM |
Affiliation:
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Gastroenterology Unit, Department of Clinical Sciences, University of Rome La Sapienza, Rome, Italy. aalisa@tin.it |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Adolescent Adult Aged Aged, 80 and over Anti-Inflammatory Agents / therapeutic use* Antibodies, Monoclonal / therapeutic use* Colectomy / utilization* Colitis, Ulcerative / drug therapy*, epidemiology, surgery* Combined Modality Therapy / statistics & numerical data Female Humans Hydrocortisone / therapeutic use Injections, Intravenous Italy / epidemiology Kaplan-Meiers Estimate Male Middle Aged Prognosis Retrospective Studies Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Anti-Inflammatory Agents; 0/Antibodies, Monoclonal; 0/infliximab; 50-23-7/Hydrocortisone |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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