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P533. Colectomy rate and mortality in hospitalized severe ulcerative colitis patients over the past 40 years

V. Clemente1, A. Aratari2, G. Burrelli Scotti1, G. Margagnoni2, C. Papi2, P. Vernia1, 1Sapienza, Dpt of Internal Medicine and Medical Specialties, Rome, Italy, 2San Filippo Neri Hospital, Gastroenterology & Hepatology Unit, Rome, Italy

Background

Approximately 15–25% of ulcerative colitis (UC) patients will experience a severe attack during the disease course. Thanks to the “Oxford Regimen” and early surgery, the prognosis of these patients has dramatically improved. Recently, rescue therapies have been shown to reduce colectomy at least in the short term, but few data are available on the long term. The aim of this study was to evaluate in-hospital colectomy and mortality rates for severe UC over the past 40 years.

Methods

In-patients with severe UC, according to Truelove and Witts criteria, from 1976 to 2010 have been retrospectively identified. Patients have been stratified in 4 cohorts according to the calendar period of hospital admission: cohort 1 (1976–1980); cohort 2 (1986–1990); cohort 3 (1996–2000); cohort 4 (2006–2010). All patients received intensive intravenous glucocorticoid treatment (IIVT). In cohort 4 infliximab (IFX) was used for not responders. No patients received cyclosporine.

Results

One hundred and fifty-nine patients have been identified: cohort 1 n = 34; cohort 2 n = 29; cohort 3 n = 45; cohort 4 n = 51. The demographic and laboratory features of patients were similar in the 4 cohorts, except for an older age and a longer disease duration in cohort 4 compared to cohorts 1, 2 and 3 (p = 0.001 and p = 0.002 respectively). The occurrence rate of local or systemic complications (toxic megacolon, massive rectal bleeding or multiple organ dysfunction) at admission or during the hospital stay was 38.2%, 24.1%, 17.7% and 15.6% in cohorts 1, 2, 3 and 4 respectively (p = 0.07). IFX was used in 17 patients in cohort 4. Overall in-hospital mortality rate was 8.8%, 6.8%, 4.4% and 0% in cohort 1, 2, 3 and 4 respectively (chi-square for trend p = 0.04). Overall in-hospital colectomy rate was 61.7%, 62.0%, 44.4% and 9.8% in cohort 1, 2, 3 and 4 respectively (p < 0.0001). The colectomy rate in the subgroup of patients with complicated disease was not different in the 4 cohorts (p = 0.1); conversely, a statistically significant reduction in colectomy rate was observed in cohort 4 in the subgroup of patients with uncomplicated disease (p < 0.0001).

Conclusion

The short term outcome of severe UC is improved in the last 40 years. A significant reduction of in-hospital colectomy rate and a trend in reduction of mortality were observed. Although the need for urgent surgery in complicated disease is unchanged in the last 40 years, a more conservative approach was observed for uncomplicated disease. A better overall in-hospital management of these patients and the use of IFX as rescue therapy in the last years may all have contributed to this improved outcome.