Improved outcome of acute severe ulcerative colitis while using early predictors of corticosteroid failure and rescue therapies

Llaó, Jordina; Naves, Juan E.; Ruíz-Cerulla, Alexandra; Gordillo, Jordi; Mañosa, Míriam; Maisterra, Sandra; Cabré, Eduard; García‐Planella, Esther; Guardiola, Jordi; Domènech, Eugeni

doi:10.1016/j.dld.2016.02.024

Cited by 17 publications

(24 citation statements)

References 33 publications

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“…These findings contrast those of Molnár et al . but are consistent with other long‐term studies . The reason for these findings could be that the individual inflammatory state not only depends on the extent but the intensity of inflammation, which in turn is influenced by genetic factors and gut microbiome .…”

Section: Discussionsupporting

confidence: 91%

“…These findings contrast those of Molnár et al 9 but are consistent with other long-term studies. 2,7,10 The reason for these findings could be that the individual inflammatory state not only depends on the extent but the intensity of inflammation, which in turn is influenced by genetic factors and gut microbiome. 18 This is particularly relevant in clinical settings where it can help the physician plan rescue therapy/colectomy in steroid NRs and manage the expectations of the patient.…”

Section: Discussionmentioning

confidence: 99%

“…As per the current literature, the most important factor predicting long‐term outcome in ASC is 7‐day response to intravenous steroids . The extent of disease as classified by the Montreal classification has been a risk factor for many long‐term outcomes in UC, including colectomy, development of CRC, and increased incidence of ASC . However, the effect of the extent of disease on the long‐term outcomes of ASC has not been studied systematically, with some studies finding extensive disease as a predictor of colectomy, whereas others did not, with median follow‐up ranging from 18 to 122 months.…”

Section: Introductionmentioning

confidence: 99%

“…2,3 The extent of disease as classified by the Montreal classification 4 has been a risk factor for many long-term outcomes in UC, including colectomy, 5 development of CRC, 6 and increased incidence of ASC. 7,8 However, the effect of the extent of disease on the long-term outcomes of ASC has not been studied systematically, with some studies finding extensive disease as a predictor of colectomy, 9 whereas others did not, 2,7,10 with median follow-up ranging from 18 to 122 months. The difference in outcome, if any, would be important in view of the management of acute episodes of severe colitis and patient counseling.…”

Section: Introductionmentioning

confidence: 99%

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Left‐sided colitis and extensive colitis have similar colectomy rates after index episode of acute severe colitis: A long‐term follow‐up study

et al. 2017

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Background and AimThe extent of disease of ulcerative colitis (UC) has been found to be a predictor of acute severe colitis (ASC), but it is unclear whether the extent of disease at the index episode of ASC is a predictor of long‐term outcome.MethodsHospitalized patients satisfying Truelove and Witts’ criteria under follow‐up at a single center from January 2003 to December 2016 were included. The extent of disease at index ASC was classified according to the Montreal classification as left‐sided or extensive colitis. Extent was used to predict the long‐term risk of colectomy or steroid dependence following an index episode of ASC.ResultsOf 2076 patients with ulcerative colitis, 241 (12%) had an index episode of ASC. In total, 34 (14%) patients underwent a colectomy at index admission and 53 (26%) over a median follow‐up of 48(1–172) months. Left‐sided colitis and extensive colitis did not differ in the rate of colectomy at index admission (12% vs 15%, P = 0.4) and colectomy in follow‐up (31% vs 23%, P = 0.17). Readmission due to ASC was also similar between the two groups (28% vs 32%, P = 0.6).ConclusionExtent of disease at index ASC does not predict colectomy at admission and over the long term.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Left‐sided colitis and extensive colitis have similar colectomy rates after index episode of acute severe colitis: A long‐term follow‐up study

et al. 2017

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“…However, infliximab with azathioprine may be more effective than ciclosporin alone to avoid colectomy [25]. Table 2 compares the results of our study with those of a recent Spanish study done in 2016 involving 62 patients with severe acute colitis [26]; it shows a high rate of colectomy in our series compared to the Spanish series, and this is due to the unsatisfactory availability of second-line medical treatment which impose us to recourse to colectomy frequently ( Table 2). The operative mortality of subtotal colectomy is null or close to 1% in the absence of complication, but it increases considerably, especially if there is colonic perforation, Thus, in one series, the operative mortality was less than 1%, whereas 25% of the patients had complicated forms (hemorrhage, perforation, colectasia) [28].…”

Section: Monterubbianesi Et Al Reported In a Study Involving 113 Patmentioning

confidence: 40%

Evolutionary Profile of Severe Acute Ulcerative Colitis in Chronic Inflammatory Bowel Diseases

Abid¹,

Babakhouya²,

Mellouki³

et al. 2018

OJGas

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Background: Severe acute colitis is a common complication of inflammatory bowel disease (IBD). Their diagnosis is based on clinical, laboratory, endoscopic and radiological. The severe acute colitis is a medical and surgical emergency; its mortality is 1% to 3%. The management should be swift and coordinated, upon admission, between medical and surgical teams. Methods: This is a retrospective study in Gastroenterology Service at the University Hospital HASSAN II Fez, over a period of 10 years (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015). We included all patients admitted for severe acute colitis; all the epidemiological, clinical, endoscopic, histological, and therapeutic monitoring of patients were collected. Results: We collected 123 patients. Their average age was 35 years (16 -70). It was a female predominance (sex ratio F/M = 1.19). 54 patients were admitted for an inaugural severe acute colitis (43%), while 69 patients were known carriers of IBD (56%). All patients were admitted to an array of severe acute colitis according to the criteria of Truelove and Witts modified. 9 patients were operated urgently because there was the presence of complications (5 cases of perforation, 3 cases of massive rectal bleeding, and one patient with an abscess in the right iliac fossa). Corticosteroids intravenously was administered to 114 patients, 74 patients (64%) had remission. Patients who have not responded to corticosteroids IV (N = 40): 1) 12 patients received treatment with oral cyclosporine: the remission rate was 66%. 2) 8 patients were put under Infliximab: The response rate was 75%. 3) Patients who have not responded to a second-line treatment underwent subtotal colectomy with a dual stoma. 4) The surgery was indicated as a second-line treatment in 20 patients who all received a subtotal colectomy with double stoma; totalizing colectomy and ileoanale anastomosis ware made in 4 patients. The mortality rate is higher in our series (12%) mainly postoperatively; it is due to the delayed admission of patients, which promotes the development of complications. Conclusion: Acute Severe Ulcerative Colitis is a medical and surgical emergency

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Ulcerative Colitis: Shifting Sands

et al. 2019

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Ulcerative colitis (UC) is a chronic inflammatory bowel disease associated with considerable disease burden. We review some current misconceptions about UC in adults with the aim of optimizing care for patients. Although UC and Crohn’s disease (CD) are considered discrete diseases, distinctions between them are not always clear-cut and phenotypes may change over time. Patient management should take into account disease manifestations, disease severity and extent, and response to prior treatments. Although disease extent often defines severity, distal UC is not always less disabling than extensive disease as patients can progress to more extensive disease. In addition, severe proctitis can give rise to severe and debilitating symptoms, with a substantial impact on health-related quality of life. UC carries an increased risk of colorectal cancer (CRC) compared with CD; however, more recent data indicate a similar risk of CRC in CD with colonic involvement as with UC. Corticosteroids are widely used to induce remission in UC, and prolonged use of steroids in patients with UC is common, but corticosteroid-free maintenance of remission is an important therapeutic goal. Although biologic therapies provide a valuable treatment option in UC, they are not clinically effective in all patients and are also associated with secondary loss of response.

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Improved outcome of acute severe ulcerative colitis while using early predictors of corticosteroid failure and rescue therapies

Cited by 17 publications

References 33 publications

Left‐sided colitis and extensive colitis have similar colectomy rates after index episode of acute severe colitis: A long‐term follow‐up study

Left‐sided colitis and extensive colitis have similar colectomy rates after index episode of acute severe colitis: A long‐term follow‐up study

Evolutionary Profile of Severe Acute Ulcerative Colitis in Chronic Inflammatory Bowel Diseases

Ulcerative Colitis: Shifting Sands

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