Prognosis of severe attacks in ulcerative colitis: Effect of intensive medical treatment

L. Benazzato, R. D'Incà, F. Grigoletto, E. Perissinotto, Valentina Medici, I. Angriman, G. G. Sturniolo

Research output: Contribution to journalArticle

46 Scopus citations

Abstract

Background. Severe attacks of ulcerative colitis have a high risk of colectomy. Aims. To evaluate the effects of standard medical management and to identify the clinical and laboratory variables capable of predicting the clinical outcome. Materials and methods. Prospective study monitoring the clinical and laboratory variables in 67 patients with severe colitis. Therapy consisted of prednisone, cyclosporin if no response, and azathioprine for maintenance. End-points were colectomy or remission. Logistic regression analysis was applied for statistical evaluation. Results. Fourteen (20%) patients required colectomy, 34 (50%) patients achieved remission with steroids, 25 (37%) patients received cyclosporin, 19 (76%) with benefit. Increased body temperature, pulse rate, sedimentation rate and C-reactive protein levels on admission were significantly associated with colectomy. Sedimentation rate greater than 75 mm/h and body temperature exceeding 38 °C at admission had 4.6- and 8.8-fold increased risk of colectomy. Less than 40% reduction in the bowel movements within 5 days predicted no response to steroids. Azathioprine maintained remission in 70% of the patients. Conclusions. Elevated sedimentation rate and fever at day 1 best predict colectomy in severe colitis. Less than 40% reduction in the bowel movements at day 5 predicts no response to steroids. Cyclosporin has a high rate of success in acute attacks and azathioprine in maintaining remission.

Original languageEnglish (US)
Pages (from-to)461-466
Number of pages6
JournalDigestive and Liver Disease
Volume36
Issue number7
DOIs
StatePublished - Jul 2004
Externally publishedYes

Keywords

  • Azathioprine
  • Cyclosporin
  • Severe colitis

ASJC Scopus subject areas

  • Gastroenterology

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    Benazzato, L., D'Incà, R., Grigoletto, F., Perissinotto, E., Medici, V., Angriman, I., & Sturniolo, G. G. (2004). Prognosis of severe attacks in ulcerative colitis: Effect of intensive medical treatment. Digestive and Liver Disease, 36(7), 461-466. https://doi.org/10.1016/j.dld.2003.12.017