Evaluation of the clinical course of acute attacks in patients with ulcerative colitis through the use of an activity index

Seo, Mitsuru; Okada, Mitsuo; Yao, Tsuneyoshi; Matake, Hiroaki; Maeda, Kazuhiro

doi:10.1007/s535-002-8129-2

Cited by 71 publications

(46 citation statements)

References 24 publications

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“…Nonetheless, to the best of our knowledge, there have been few studies on the short-term outcomes of ASUC in non-Caucasian populations. [14][15][16][17][18][19] Furthermore, the long-term outcomes, i.e., up to 10 years, of ASUC in these nonCaucasian populations have never been addressed. Hence, the aim of this study was to assess treatment responses and their short-and long-term consequences in Korean patients with ASUC.…”

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confidence: 99%

Short- and Long-Term Outcomes of Acute Severe Ulcerative Colitis in Korea

Lee

Yang

Soh

et al. 2015

Inflammatory Bowel Diseases

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confidence: 99%

Short- and Long-Term Outcomes of Acute Severe Ulcerative Colitis in Korea

Lee

Yang

Soh

et al. 2015

Inflammatory Bowel Diseases

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“…In patients with UC, lack of response to steroids, chronic continuous symptoms, and persistently elevated inflammatory markers have all been shown to predict colectomy in hospitalized patients (33)(34)(35). Although most studies agree that patients with pancolitis are more likely to require colectomy than those with relatively limited disease, there is limited data concerning other factors that predict the need for colectomy in patients with longstanding disease.…”

Section: Discussionmentioning

confidence: 99%

Clinical course and predictors of total colectomy in ulcerative colitis; a referral center experience from Turkey

Kalkan

Dağlı²,

Kekilli³

et al. 2015

Turk J Gastroenterol

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Background/Aims: We aimed to describe the clinical course of Ulcerative colitis (UC) and the factors that predict the need for total colectomy in Turkish patients with severe UC receiving regular follow up. Materials and Methods: We analyzed the demographic and clinical characteristics of 612 patients with UC receiving regular follow up between 1994 and 2010 in a tertiary referral center in Ankara. Results: Men accounted for 58% of patients (M:F ratio, 1.4:1), and the mean age at diagnosis was 37.9 years. Of these, 32% had distal colitis and 8.8% had further extension, and 39 patients (6.4%) had chronic active disease. Steroid dependency and steroid resistance rates were 7.5% and 17.2%, respectively. In multivariate analysis, steroid dependency (p=0.04), steroid resistance (p=0.002), further extension (p<0.001), presence of extensive disease (p=0.006), and chronic active disease (p<0.001) were independent predictors of the need for total colectomy. Patients with chronic active disease had lower total colectomy free survival (p<0.001). Conclusion: The predictors of total colectomy were comparable with those previously reported in the literature. However, we identified further extension in disease localization to predict the need for total colectomy.

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“…Four indices in adults have been developed to predict corticosteroid failure on the third treatment day in order to facilitate timely introduction of second-line therapy when needed. [33][34][35]56 Of these, the Travis score (i.e., the Oxford index) is the most widely used: stool frequency of >8/day or 3-8/day with CRP >45 mg/L on the third day of therapy had a positive predictive value (PPV) of 85% for colectomy. 34 In children, a predictive rule based on the PUCAI score at days 3 and 5 of steroid therapy has been implemented 12 and proved, in a head-to-head prospective study, to be superior to the four adult scores.…”

Section: Indications For Second-line Therapymentioning

confidence: 99%

Acute severe ulcerative colitis in children: A systematic review

Turner

Griffiths

2011

Inflammatory Bowel Diseases

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Pediatric ulcerative colitis (UC) has a more severe phenotype, reflected by more extensive disease and a higher rate of acute severe exacerbations. The pooled steroid-failure rate among 291 children from five studies is 34% (95% confidence interval [CI]: 27%-41%). It is suggested that corticosteroids should be dosed between 1-1.5 mg/kg up to 40-60 mg daily. Food restriction has a limited role in severe UC and should be generally discouraged in children who do not have a surgical abdomen. Appraisal of radiologic findings in children must recognize the variation in colonic width with age and size. Data suggest that the Pediatric UC Activity Index (PUCAI), determined at day 3, should be used to screen for patients likely to fail corticosteroids (>45 points), and at day 5 to dictate the introduction of second-line therapy (>65-70 points). Cyclosporine is successful in children with severe colitis but its use should be restricted to 3-4 months while bridging to thiopurine treatment (pooled short-term success rate 81% [95% CI: 76%-86%]; n = 94 from eight studies). Infliximab may be as effective as cyclosporine (75% pooled short-term response (95% CI: 67%-83%); n = 126, six studies) with a pooled 1-year response of 64% (95% CI: 56%-72%). In toxic megacolon, in patients refractory to one salvage medical therapy, and in chronic severe disease, colectomy may be preferred. Decision-making regarding colectomy in children must consider the toxicity of medication consumed over many future years, the quality of life and self-image associated with either choice, as well as both functional outcomes and, in females, fertility following pouch procedures.

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Evaluation of the clinical course of acute attacks in patients with ulcerative colitis through the use of an activity index

Abstract: We concluded that patients with an AI value in excess of 200 after 2 weeks of medical therapy would require surgical treatment.

Cited by 71 publications

References 24 publications

Short- and Long-Term Outcomes of Acute Severe Ulcerative Colitis in Korea

Short- and Long-Term Outcomes of Acute Severe Ulcerative Colitis in Korea

Clinical course and predictors of total colectomy in ulcerative colitis; a referral center experience from Turkey

Acute severe ulcerative colitis in children: A systematic review

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