Search in the Abstract Database

Search Abstracts 2016

* = Presenting author

P162 Outcome of 114 patients admitted with acute severe ulcerative colitis over 5 years at a district general hospital

K. Wade, H. Johnson*, S. Weaver, S. McLaughlin

Royal Bournemouth Hospital, Department of Gastroenterology, Bournemouth, United Kingdom

Background

Research shows that 15% of ulcerative colitis (UC) patients develop acute severe UC (ASUC) with mortality of 2.9% and colectomy risk of 30%.1 BSG IBD guidelines 2011 recommend excluding C. difficile and enteric infection and starting intravenous steroid therapy and prophylactic heparin within 24 hours and sigmoidoscopy within 3 days. Rescue therapy or surgery should be considered between days 3 and 5 if colitis is not settled. In addition, colectomy (if needed) should be performed or assisted by a consultant colorectal surgeon

Methods

We searched our database to identify patients admitted with a diagnosis of ASUC between 1/08/09 and 31/07/14. We reviewed case notes and compared outcomes to the guidelines. Results: 114 patients admitted with ASUC, 62 (54.4%) male, mean age = 56 (range 16–94).

Results

27 (23.7%) = first presentation of UC.

98 (86%) tested for C. difficile, 2% (2) positive; 97 (85.1%) tested for enteric infection, 3 (3.1%) positive.

82 (71.9%) patients started prophylactic heparin day 1.

100 (87.7%) given IV hydrocortisone 65 (65.7%) < 24 hours, 14 (12.3%) prescribed oral steroids, or antibiotics (moderate first distal disease presentation).

Sigmoidoscopy performed in 89 (78.1%) patients, mean = 3 days after admission, 43 (48.9%) CMV requested.

23 (20.2%) commenced rescue therapy, 16 (69.6%) Infliximab; (30.4%) ciclosporin, mean = 5 d IV hydrocortisone before rescue therapy (range = 1–8).

47 (41.2%) had a surgical review. 21 (44.7%) by consultant colorectal surgeon; 23 (48.9%) by surgical registrar; 3 (6.4%) by general surgical colleague.

21 (18.4%) underwent surgery, mean = 6 days from starting rescue therapy to surgery (range = 1–10). 17 (81%) had surgery performed by consultant colorectal surgeon; 2 (9.5%) specialist registrar. 2 (9.5%) upper GI surgical consultant (1 an emergency late Friday evening, and 1 Sunday after correction of potassium levels); 19 (90.5%) on a weekday and 2 (9.5%) at the weekend; the second weekend patient by the on-call colorectal consultant.

11 (52.4%) rescue therapy not started before surgery; 3 (27.3%) previously received infliximab; 1 (9.1%) patient choice; 2 (18.2%) patients acutely unwell; 5 (45.4%) decision to be managed surgically.

To date, 4 (19%) had pouch surgery; 6 (28.6%) proctectomy; 4 (19%) awaiting surgery for pouch/proctectomy; 7 (33.4%) rectum in situ with surveillance.

1 patient died during admission due to aspiration pneumonia.

Conclusion

Areas for improvement are commencing IV hydrocortisone within 24 hours, obtaining stools samples, including CMV in histopathology, and considering escalating therapy after 72 hours of IV hydrocortisone. By assessing and evaluating patients admitted with ASUC, we continue to advance our management.

References

[1] Edwards FC, Truelove SC. The course and prognosis of ulcerative colitis. GUT 1963;4:299–315.