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P730 Short and long-term outcome of acute severe colitis

G. Marwa*1, M. Ghanem1

1Medical University of Tunis, Gastroenterology, Tunis, Tunisia

Background

The acute severe colitis is a serious complication of inflammatory bowel disease(IBD). It can lead to colectomy and death. Its medical treatment has been step forward within the last decades. Hence, an improvement of the prognosis of this life-threatening disease has to be proven.

Methods

All patients admitted for acute severe colitis have been retrospectively enrolled, between the years 2000 and 2018. Demographic , clinical, laboratory and endoscopic data were gathered. Standard therapy based on intravenous corticosteroids was initially led in all patients. Short and long-term evolution has been reported, precising the rate of proceeding to cyclosporine or infliximab and referral to colectomy.

Results

62 patients with acute severe colitis were reviewed (median age: 31 years (12–60 years); 34 females and 30 males). There were 57.8% with ulcerative colitis, 34.4% with Crohn’s disease and 6.3% with indeterminate colitis. 54.7% of severe colitis occur on an already known underlying IBD. 25.7% of them were not receiving any immunosuppressive therapy. A super-imposed infection was reported in 5 patients ( Salmonella in three cases and CMV in two cases). Forty-four patients (68.8%) responded to a first-line treatment. Among patients with steroid-refractory colitis (20 patients), urgent colectomy was performed in 5 cases , 10 patients received infliximab( 5 mg/kg on days 0, 14 and 42) and 5 patients received cyclosporin (2 mg/kg per day). Ninety per cent of patients given infliximab had a clinical response compared with 80% given ciclosporin. These two drugs have equivalent efficacy as a rescue therapy in steroid-refractory acute severe colitis (p = 0.59). After a median follow-up of 76 months, colectomy- free survival rates at 1 and 5 years were, respectively, 77% and 63%. Cumulative incidence of first infliximab use at 1 and 5 years was, respectively, 12% and 32%. Two patients died due to severe septique complications.

Conclusion

The first severe flare of IBD responds often to steroids. Our study further confirms a similar efficacy of both infliximab and ciclosporin as a rescue therapy. Colectomy rate and mortality are still high in acute – phase. Nevertheless, the long-term prognosis is excellent.