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P274. Response to intravenous steroid therapy in the first few days of hospitalization determines the subsequent risk of colectomy in newly diagnosed ulcerative colitis patients

K. Farkas, Z. Szepes, F. Nagy, T. Wittmann, T. Molnar

First Department of Medicine, University of Szeged, Szeged, Hungary

Introduction: A severe flare-up develops in approximately 15% of patients with ulcerative colitis (UC). It is questionable whether the response to parenteral corticosteroid therapy decreases the risk for colectomy in the subsequent years after the first hospitalization.

Our aim was to evaluate the association between long-term colectomy rate and the efficacy of steroid in the first few days of the therapy and to assess other predictive factors for colectomy in our newly diagnosed UC patients hospitalized because of first severe attack of UC.

Patients and Methods: From 1998 to 2005 the records of the first hospitalizations of a total of 183 UC patients with severe exacerbation of UC were retrospectively reviewed. Every patient had received parenteral corticosteroid treatment. Patients who failed to respond to intravenous steroid therapy, received cyclosporine or infliximab. Colectomy was performed in refractory UC or in case of intolerable side-effects of the rescue therapy. We compared different laboratory and clinical parameters between patients undergoing colectomy and those who avoided surgery.

Results: Clinical response to steroid therapy was achieved in 110 of the 183 patients with acute severe UC. 14.5% of steroid responder patients were operated on during the follow-up period. 39.7% of patients in the steroid-refractory group needed either urgent or late colectomy. The overall colectomy rate was 24.6%. Unresponsiveness to intravenous steroid therapy, anemia, the need for blood transfusion proved to be the major predictors for subsequent colectomy.

Discussion: The colectomy rate during the first 7 years after the diagnosis was 2.5 times higher in our patients with acute severe UC not responding to the initial intensive steroid therapy suggesting that the response to the therapy of the first 3–5 days of the hospitalization may determine the long-term outcome and colectomy rate in UC.