Predicting outcome in severe ulcerative colitis.
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Journal: 1997/January - Gut
ISSN: 0017-5749
PUBMED: 8984031
Abstract:
BACKGROUND
Simple criteria are needed to predict which patients with severe ulcerative colitis will respond poorly to intensive medical treatment and require colectomy.
OBJECTIVE
To find out if the early pattern of change in inflammatory markers or other variables could predict the need for surgery and to evaluate the outcome of medical treatment during one year follow up.
METHODS
51 consecutive episodes of severe colitis (Truelove and Witts criteria) affecting 49 patients admitted to John Radcliffe Hospital, Oxford.
METHODS
Prospective study monitoring 36 clinical, laboratory, and radiographic variables. All episodes treated with intravenous and rectal hydrocortisone and 14 of 51 with cyclosporine.
RESULTS
Complete response in 21 episodes (< or = 3 stools on day 7, without visible blood), incomplete response in 15 >> 3 stools or visible blood on day 7, but no colectomy), and colectomy on that admission in 15. During the first five days, stool frequency and C reactive protein (CRP) distinguished between outcomes (p < 0.00625, corrected for multiple comparisons) irrespective of whether patients or the number of episodes were analysed. It could be predicted on day 3, that 85% of patients with more than eight stools on that day, or a stool frequency between three and eight together with a CRP>> 45 mg/l, would require colectomy. For patients given cyclosporine, four of 14 avoided colectomy but two continued to have symptoms. After admission, complete responders remained in remission for a median nine months and had a 5% chance of colectomy. Incomplete responders had a 60% chance of continuous symptoms and 40% chance of colectomy.
CONCLUSIONS
After three days intensive treatment, patients with frequent stools >> 8/day), or raised CRP >> 45 mg/l) need to be identified, as most will require colectomy on that admission. The role of cyclosporine for treating severe colitis has yet to be defined. After seven days' treatment, patients with>> 3 stools/day of visible blood have a 60% chance of continuous symptoms and 40% chance of colectomy in the following months.
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Gut 38(6): 905-910
PMID: 8984031

Predicting outcome in severe ulcerative colitis.

Abstract

BACKGROUND: Simple criteria are needed to predict which patients with severe ulcerative colitis will respond poorly to intensive medical treatment and require colectomy. AIMS: To find out if the early pattern of change in inflammatory markers or other variables could predict the need for surgery and to evaluate the outcome of medical treatment during one year follow up. PATIENTS: 51 consecutive episodes of severe colitis (Truelove and Witts criteria) affecting 49 patients admitted to John Radcliffe Hospital, Oxford. METHODS: Prospective study monitoring 36 clinical, laboratory, and radiographic variables. All episodes treated with intravenous and rectal hydrocortisone and 14 of 51 with cyclosporine. RESULTS: Complete response in 21 episodes (< or = 3 stools on day 7, without visible blood), incomplete response in 15 (> 3 stools or visible blood on day 7, but no colectomy), and colectomy on that admission in 15. During the first five days, stool frequency and C reactive protein (CRP) distinguished between outcomes (p < 0.00625, corrected for multiple comparisons) irrespective of whether patients or the number of episodes were analysed. It could be predicted on day 3, that 85% of patients with more than eight stools on that day, or a stool frequency between three and eight together with a CRP > 45 mg/l, would require colectomy. For patients given cyclosporine, four of 14 avoided colectomy but two continued to have symptoms. After admission, complete responders remained in remission for a median nine months and had a 5% chance of colectomy. Incomplete responders had a 60% chance of continuous symptoms and 40% chance of colectomy. CONCLUSIONS: After three days intensive treatment, patients with frequent stools (> 8/day), or raised CRP (> 45 mg/l) need to be identified, as most will require colectomy on that admission. The role of cyclosporine for treating severe colitis has yet to be defined. After seven days' treatment, patients with > 3 stools/day of visible blood have a 60% chance of continuous symptoms and 40% chance of colectomy in the following months.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • EDWARDS FC, TRUELOVE SC. THE COURSE AND PROGNOSIS OF ULCERATIVE COLITIS. Gut. 1963 Dec;4:299–315.[PMC free article] [PubMed] [Google Scholar]
  • GALLAGHER ND, GOULSTON SJ, WYNDHAM N, MORROW W. The management of fulminant ulcerative colitis. Gut. 1962 Dec;3:306–311.[PMC free article] [PubMed] [Google Scholar]
  • Truelove SC, Jewell DP. Intensive intravenous regimen for severe attacks of ulcerative colitis. Lancet. 1974 Jun 1;1(7866):1067–1070. [PubMed] [Google Scholar]
  • Ritchie JK. Results of surgery for inflammatory bowel disease: a further survey of one hospital region. Br Med J. 1974 Feb 16;1(5902):264–268.[PMC free article] [PubMed] [Google Scholar]
  • Truelove SC, Willoughby CP, Lee EG, Kettlewell MG. Further experience in the treatment of severe attacks of ulcerative colitis. Lancet. 1978 Nov 18;2(8099):1086–1088. [PubMed] [Google Scholar]
  • Järnerot G, Rolny P, Sandberg-Gertzén H. Intensive intravenous treatment of ulcerative colitis. Gastroenterology. 1985 Nov;89(5):1005–1013. [PubMed] [Google Scholar]
  • Jones HW, Grogono J, Hoare AM. Acute colitis in a district general hospital. Br Med J (Clin Res Ed) 1987 Mar 14;294(6573):683–684.[PMC free article] [PubMed] [Google Scholar]
  • Lichtiger S, Present DH, Kornbluth A, Gelernt I, Bauer J, Galler G, Michelassi F, Hanauer S. Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med. 1994 Jun 30;330(26):1841–1845. [PubMed] [Google Scholar]
  • Lennard-Jones JE, Ritchie JK, Hilder W, Spicer CC. Assessment of severity in colitis: a preliminary study. Gut. 1975 Aug;16(8):579–584.[PMC free article] [PubMed] [Google Scholar]
  • Buckell NA, Lennard-Jones JE, Hernandez MA, Kohn J, Riches PG, Wadsworth J. Measurement of serum proteins during attacks of ulcerative colitis as a guide to patient management. Gut. 1979 Jan;20(1):22–27.[PMC free article] [PubMed] [Google Scholar]
  • Meyers S, Lerer PK, Feuer EJ, Johnson JW, Janowitz HD. Predicting the outcome of corticoid therapy for acute ulcerative colitis. Results of a prospective, randomized, double-blind clinical trial. J Clin Gastroenterol. 1987 Feb;9(1):50–54. [PubMed] [Google Scholar]
  • Chew CN, Nolan DJ, Jewell DP. Small bowel gas in severe ulcerative colitis. Gut. 1991 Dec;32(12):1535–1537.[PMC free article] [PubMed] [Google Scholar]
  • TRUELOVE SC, WITTS LJ. Cortisone in ulcerative colitis; preliminary report on a therapeutic trial. Br Med J. 1954 Aug 14;2(4884):375–378.[PMC free article] [PubMed] [Google Scholar]
  • Jewell DP. How I do it. Medical management of severe ulcerative colitis. Int J Colorectal Dis. 1988 Aug;3(3):186–189. [PubMed] [Google Scholar]
  • Rees DC, Satsangi J, Cornelissen PL, Travis SP, White J, Jewell DP. Are serum concentrations of nitric oxide metabolites useful for predicting the clinical outcome of severe ulcerative colitis? Eur J Gastroenterol Hepatol. 1995 Mar;7(3):227–230. [PubMed] [Google Scholar]
Gastroenterology Unit, John Radcliffe Hospital, Oxford.
Gastroenterology Unit, John Radcliffe Hospital, Oxford.
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Abstract
BACKGROUND: Simple criteria are needed to predict which patients with severe ulcerative colitis will respond poorly to intensive medical treatment and require colectomy. AIMS: To find out if the early pattern of change in inflammatory markers or other variables could predict the need for surgery and to evaluate the outcome of medical treatment during one year follow up. PATIENTS: 51 consecutive episodes of severe colitis (Truelove and Witts criteria) affecting 49 patients admitted to John Radcliffe Hospital, Oxford. METHODS: Prospective study monitoring 36 clinical, laboratory, and radiographic variables. All episodes treated with intravenous and rectal hydrocortisone and 14 of 51 with cyclosporine. RESULTS: Complete response in 21 episodes (< or = 3 stools on day 7, without visible blood), incomplete response in 15 (> 3 stools or visible blood on day 7, but no colectomy), and colectomy on that admission in 15. During the first five days, stool frequency and C reactive protein (CRP) distinguished between outcomes (p < 0.00625, corrected for multiple comparisons) irrespective of whether patients or the number of episodes were analysed. It could be predicted on day 3, that 85% of patients with more than eight stools on that day, or a stool frequency between three and eight together with a CRP > 45 mg/l, would require colectomy. For patients given cyclosporine, four of 14 avoided colectomy but two continued to have symptoms. After admission, complete responders remained in remission for a median nine months and had a 5% chance of colectomy. Incomplete responders had a 60% chance of continuous symptoms and 40% chance of colectomy. CONCLUSIONS: After three days intensive treatment, patients with frequent stools (> 8/day), or raised CRP (> 45 mg/l) need to be identified, as most will require colectomy on that admission. The role of cyclosporine for treating severe colitis has yet to be defined. After seven days' treatment, patients with > 3 stools/day of visible blood have a 60% chance of continuous symptoms and 40% chance of colectomy in the following months.
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