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P555. Conservative approach results in lower colectomy rates in patients with severe ulcerative colitis – data from 70 patients with S3 in the ICURE study

D. Sjöberg1, M. Larsson2, A.-l. Nielsen2, L. Holmqvist3, A. Rönnblom4, 1Falu Hospital, Department of Medicine, Falun, Sweden, 2Mälarsjukhuset, Department of Medicine, Eskilstuna, Sweden, 3Akademiska Sjukhuset, Department of Pediatrics, Uppsala, Sweden, 4Akademiska Sjukhuset, Department of Gastroenterology, Uppsala, Sweden

Background

Steroids have been the cornerstone in treating patients with severe ulcerative colitis (UC) since 1955. Previous data estimate the risk for colectomy to 25–50%. During the last decade infliximab has been added, but it is still unclear if the colectomy frequency has decreased. The ICURE-study (IBD Cohort of Uppsala Region) provides a population based cohort in which this question can be illuminated.

Methods

All patients with newly diagnosed UC in Uppsala County during 2005–2009 and in the Uppsala Region 2007–2009 were registered. The mean incidence was 20.0/100,000/year. Of 526 UC patients, 70 (13%) developed a severe relapse during follow-up of 3.3 (SD±1.9) years.

Results

The colectomy rate was 15/70 (21%) during the first 90 days and 17/70 (24%) during follow-up. One patient was treated with infliximab only and entered remission. Forty-six (66%) patients responded to steroids alone. Nine (13%) patients did not respond to steroids and went straight for colectomy. Fourteen (20%) patients not responding to steroids were given infliximab. Eight of these patients went to remission and six went to colectomy. An additional two patients in the infliximab group later went to colectomy. One patient died in a postoperative complication (sepsis).

A conservative approach to colectomy at the Uppsala University Hospital resulted in significantly lower colectomy rates (7% vs 41%, P < 0.05).

There were no differences in Truelove-Witt criteria or steroid doses. The use of infliximab was even significantly lower in Uppsala (3/41 vs 11/29, P < 0.01).

Table 1
 RemissionColectomy
  ≤90 daysLate-term, >90 days
Infliximab only1
Steroids only469
Steroids and infliximab662
Table 2
 Colectomy ≤90 daysNo colectomy ≤90 days
Uppsala338
Other hospitals1217

Conclusion

The need for colectomy is based on a number of variables such as clinical condition, endoscopic findings and laboratory results. The decision should not be rushed due to lack of immediate improvement to steroids or biologic treatment. A clear outspoken conservative approach to surgery might save patients their colon without jeopardizing health or long term results.