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* = Presenting author

P272. Outcome of cyclosporine rescue therapy or surgery in patients with steroid-refractory ulcerative colitis: Both improve the quality of life despite of the frequent complications

Z. Szepes1, K. Farkas1, G. Horvath2, F. Nagy1, T. Nyari3, T. Wittmann1, T. Molnar1

1First Department of Medicine, University of Szeged, Szeged, Hungary; 2Department of Gastroenterology, Semmelweis Health Centre of Miskolc, Szeged, Hungary; 3Department of Medical Informatics, University of Szeged, Szeged, Hungary

Introduction: Patients with ulcerative colitis (UC) usually can not accept the need for colectomy at all; however, rescue therapies may cause severe side-effects. Our therapeutic decision remains theoretical in this life-threatening situation in the lack of comparative data. The aim of our study was to evaluate and to compare the outcome and the changes of quality of life in patients with steroid-refractory UC before and after cyclosporine rescue therapy or colectomy.

Patients and Methods: 90 steroid-refractory UC patients (mean age at the diagnosis: 31.3 years [12–69 years], female/male ratio: 52/38) who were hospitalized in our tertiary clinic between 1998 and 2007 were involved in the study. Data of 46 patients undergoing colectomy and data of 44 patients responding to cyclosporine therapy were analyzed retrospectively. Every patient assessed their quality of life at the time of the diagnosis of UC, three month before and half year after cyclosporine introduction/colectomy and also at the last visit. The number of hospitalizations, outpatient visits, and medication used before and after the surgical and conservative therapeutic method was compared statistically in both groups.

Results: 74% of the colectomized patients underwent ileal pouch anal anastomosis (IPAA) procedure. The average duration of the temporary ileostomy was 5 months. Early complications occurred in 52.1% of the patients. Frequency of the in- and outpatient admissions, and the number of medications decreased significantly after colectomy (p < 0.001). Quality of life improved significantly even in the first 6 months after the surgery vs. the preoperative period. Patients with pouchitis also assessed their quality of life significantly better after the colectomy than at the diagnosis (p < 0.001). Adverse events occurred in 88.9% of the cyclosporine treated patients and led to treatment discontinuation in 20.9% of the cases. The frequency of the in- and outpatient visits, and the number of medications did not decreased significantly after the introduction of cyclosporine. Quality of life improved significantly even in the first 6 months after starting cyclosporine therapy vs. the diagnosis of UC and 3 months before the initiation of the therapy (p < 0.001). Interestingly, patient who underwent colectomy revealed significantly better quality of life at 6 months than those who received the drug (p = 0.001).

Discussion: In this study we examined the outcome and influence of colectomy and cyclosporine therapy on the quality of life in Hungarian patients with acute, severe UC. Although our data show that both cyclosporine rescue therapy and colectomy can result in a good quality of life; frequent side-effects of cyclosporine and the need for maintenance immunosuppression or the common postoperative complications indicates that there is still need for better therapeutic tools.