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Long-term outcomes of acute severe ulcerative colitis in the rescue therapy era: A multicentre cohort study.
Festa, Stefano; Scribano, Maria L; Pugliese, Daniela; Bezzio, Cristina; Principi, Mariabeatrice; Ribaldone, Davide G; Allocca, Mariangela; Mocci, Giammarco; Bodini, Giorgia; Spagnuolo, Rocco; Vernia, Piero; Mazzuoli, Silvia; Costa, Francesco; Barberio, Brigida; Cosintino, Rocco; Zerboni, Giulia; Aratari, Annalisa; Armuzzi, Alessandro; Papi, Claudio.
Afiliação
  • Festa S; IBD Unit, San Filippo Neri Hospital, Rome, Italy.
  • Scribano ML; Gastroenterology Unit, AO San Camillo Forlanini, Rome, Italy.
  • Pugliese D; IBD Unit, Università Cattolica del Sacro Cuore, Rome, Italy.
  • Bezzio C; Gastroenterology Unit, Rho Hospital, Rho, Italy.
  • Principi M; Emergency and Organ Transplantation Department, AOU Policlinico, Bari, Italy.
  • Ribaldone DG; Department of Medical Sciences, University of Turin, Turin, Italy.
  • Allocca M; IBD Centre, Humanitas University, Milan, Italy.
  • Mocci G; Gastroenterology Unit, Brotzu Hospital, Cagliari, Italy.
  • Bodini G; Department of Internal Medicine, University of Genoa, Genoa, Italy.
  • Spagnuolo R; Gastroenterology Unit, University Magna Graecia, Catanzaro, Italy.
  • Vernia P; Division of Gastroenterology, Sapienza University of Rome, Rome, Italy.
  • Mazzuoli S; Gastroenterology Unit, Monsignor Raffaele Dimiccoli Hospital, Barletta, Italy.
  • Costa F; IBD Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
  • Barberio B; Gastroenterology Section, University of Padua, Padua, Italy.
  • Cosintino R; Gastroenterology Unit, AO San Camillo Forlanini, Rome, Italy.
  • Zerboni G; IBD Unit, San Filippo Neri Hospital, Rome, Italy.
  • Aratari A; IBD Unit, San Filippo Neri Hospital, Rome, Italy.
  • Armuzzi A; IBD Unit, Università Cattolica del Sacro Cuore, Rome, Italy.
  • Papi C; IBD Unit, San Filippo Neri Hospital, Rome, Italy.
United European Gastroenterol J ; 9(4): 507-516, 2021 05.
Article em En | MEDLINE | ID: mdl-33259773
BACKGROUND: The long-term course of ulcerative colitis after a severe attack is poorly understood. Second-line rescue therapy with cyclosporine or infliximab is effective for reducing short-term colectomy but the impact in the long-term is controversial. OBJECTIVE: The purpose of this study was to evaluate the long-term course of acute severe ulcerative colitis patients who avoid early colectomy either because of response to steroids or rescue therapy. METHODS: This was a multicentre retrospective cohort study of adult patients with acute severe ulcerative colitis admitted to Italian inflammatory bowel disease referral centres from 2005 to 2017. All patients received intravenous steroids, and those who did not respond received either rescue therapy or colectomy. For patients who avoided early colectomy (within 3 months from the index attack), we recorded the date of colectomy, last follow-up visit or death. The primary end-point was long-term colectomy rate in patients avoiding early colectomy. RESULTS: From the included 372 patients with acute severe ulcerative colitis, 337 (90.6%) avoided early colectomy. From those, 60.5% were responsive to steroids and 39.5% to the rescue therapy. Median follow-up was 44 months (interquartile range, 21-85). Colectomy-free survival probability was 93.5%, 81.5% and 79.4% at 1, 3 and 5 years, respectively. Colectomy risk was higher among rescue therapy users than in steroid-responders (log-rank test, p = 0.02). At multivariate analysis response to steroids was independently associated with a lower risk of long-term colectomy (adjusted odds ratio = 0.5; 95% confidence interval, 0.2-0.8), while previous exposure to antitumour necrosis factor-α agents was associated with an increased risk (adjusted odds ratio = 3.0; 95% confidence interval, 1.5-5.7). Approximately 50% of patients required additional therapy or new hospitalisation within 5 years due to a recurrent flare. Death occurred in three patients (0.9%). CONCLUSIONS: Patients with acute severe ulcerative colitis avoiding early colectomy are at risk of long-term colectomy, especially if previously exposed to antitumour necrosis factor-α agents or if rescue therapy during the acute attack was required because of steroid refractoriness.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Colite Ulcerativa / Glucocorticoides Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Colite Ulcerativa / Glucocorticoides Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2021 Tipo de documento: Article