Document Detail


Colectomy rate in acute severe ulcerative colitis in the infliximab era.
MedLine Citation:
PMID:  18472316     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
A Aratari; C Papi; V Clemente; A Moretti; R Luchetti; M Koch; L Capurso; R Caprilli
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Publication Detail:
Type:  Journal Article     Date:  2008-05-09
Journal Detail:
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:
Created Date:  2008-08-18     Completed Date:  2008-09-18     Revised Date:  2009-05-20    
Medline Journal Info:
Nlm Unique ID:  100958385     Medline TA:  Dig Liver Dis     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  821-6     Citation Subset:  IM    
Affiliation:
Gastroenterology Unit, Department of Clinical Sciences, University of Rome La Sapienza, Rome, Italy. aalisa@tin.it
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MeSH Terms
Descriptor/Qualifier:
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:
0/Anti-Inflammatory Agents; 0/Antibodies, Monoclonal; 0/infliximab; 50-23-7/Hydrocortisone

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