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P566. Clinical course of severe colitis; a comparison between Crohn's colitis and ulcerative colitis

E. Sinagra1, F. Mocciaro1, A. Scalisi1, V. Criscuoli1, A. Orlando1, M. Olivo1, M. Giunta1, M. Cottone1, 1Ospedali Riuniti Villa Sofia – Cervello, DIBIMIS, Division of Internal Medicine, Palermo, Italy

Background

Few data are available about the clinical course of severe colonic Crohn's disease. Usually, although supporting evidence is limited, severe colitis not responding to the medical treatment should be treated with surgical intervenction, because of the risk of perforation or toxic megacolon. The aim is to describe the clinical course of severe Crohn's colitis in a patients cohort with isolated colonic or ileocolonic CD, and to compare it with the clinical course of patients with severe ulcerative colitis (UC).

Methods

34 Patients with severe Crohn's colitis were retrospectively identified in our cohort of 593 hospitalized patients (2003–2012) through the evaluation of Crohn's Disease Activity Index score and Harvey–Bradshaw Index. 169 Patients with severe ulcerative colitis were retrospectively identified in our cohort of 449 hospitalized patients (2003–2012) through the evaluation of Lichtiger score and Truelove–Witts score. We evaluated the following outcomes: response to steroids, response to biologics, acute colectomy rate, colectomy rate during follow-up, megacolon and cytomegalovirus infection rate.

Results

We did not find significant differences in the response to steroids and to biologics, in the percentage of cytomegalovirus infection and of megacolon, while the rate of colectomy in acute turned out to be greater in patients with severe Crohn's colitis compared to patients with severe UC, and this difference appeared to be the limit of statistical significance (Chi square 3.31, p = 0.069, OR 0.39); the difference between the colectomy rates at the end of follow up was also not significant. In the whole population by univariate analysis, according to the linear regression model, a young age at diagnosis is associated with an increased risk of colectomy in absolute (p = 0.024) and in election (p = 0.022), but not in acute, as well as an elevated ESR is correlated with an increased risk of colectomy absolute (p = 0.014) and in acute (p = 0.032), but not in the election. This correlation was significant on multivariate analysis.

Conclusion

The overall rate of colectomy in the cohort of patients with severe Crohn's colitis is greater than that of our cohort of patients with severe UC, but this figure is not supported by a different clinical response to steroid therapy or rescue therapy with biologics. The real clinical course of severe Crohn's colitis requires to be clarified by prospective studies that include a larger number of patients in this subgroup of disease.