P456 Longer-term outcomes in acute severe colitis
R. CAMPBELL, R. Haddock, K. Parman, J. MacDonald, J.P. Seenan
Gastroenterology, Queen Elizabeth University Hospital, Glasgow, UK
Background
Acute severe ulcerative colitis (ASUC) is a medical emergency. Rescue medical therapy is increasingly used in steroid-refractory patients but has historically been considered to delay rather than prevent colectomy. We have previously described short-term outcomes from our unit of cases of ASUC, as defined by Truelove and Witt’s criteria, over a 1 year period (July 2016 to June 2017). Data on longer-term outcomes is now available.
Methods
Electronic patient records (EPRs) of cases included in the original study were reviewed. Outcomes including readmission rates, need for colectomy, steroid use, medical escalation and rates of biochemical remission (as defined by faecal Calprotectin (FC) <250μg/l) were recorded.
Results
In total, 58 cases (51 patients) were included in original cohort. 19 failed initial medical therapy with steroids with 10 successfully treated using rescue medical therapy thus avoiding colectomy. Only 1/10 required subsequent colectomy during our median follow-up period of 32 months.
29/51 (56.9%) patients settled with steroids alone. 3 died of unrelated causes so were excluded from further analysis. Further oral steroids were prescribed in 53.8% (14/26).
6 patients were already receiving an immunomodulator (azathioprine or mercaptopurine) prior to initial presentation. 75% of the remainder (15/20) were discharged on aminosalicylates as their only maintenance therapy but the majority (60%, 9/15) subsequently required medical escalation with only 30% (6/20) continuing aminosalicylate monotherapy. 1 colectomy also occurred in this group.
17 readmissions occurred in 12 patients with the majority (52.9%, 9/17) within 1 year. At the end of follow-up two out of three patients (66.7%, 12/18) were considered to be in biochemical remission (FC <250 μg/l).
Conclusion
Rescue medical therapy for ASUC provides sustained benefit with the vast majority avoiding delayed colectomy. Patients admitted with ASUC have significant readmission rates, particularly within 1 year with frequent need for further steroids and/or escalation of medical therapy. Long-term remission rates are high but aminosalicylate monotherapy is rarely adequate to achieve this. All patients with an adequate response to treatment for ASUC should be considered for initiation of immunomodulator and/or biologic Rx prior to discharge. ASUC patients should be considered for more intensive follow-up and early, aggressive medical escalation. An enhanced inpatient liaison service and early review clinic is planned to support this.