BACKGROUND: Approximately one third of patients with acute severe ulcerative colitis (ASUC) fail response to steroids. Ciclosporin and anti-TNFα are proven second-line therapies, but evidence of their efficacy has come mainly from tertiary centres and/or selective clinical trial recruitment. AIM: To assess ASUC outcomes in a large unselected cohort. METHODS: UK-wide audits of IBD care were conducted in 2008 (209 hospital sites) and 2010 (198 hospital sites), covering >87% of admitting hospitals. Each site entered data from 20 consecutive UC admissions onto a web-based proforma. Admissions included 852 (2008) and 984 (2010) with ASUC, accounting for 35% and 39% of UC admissions, respectively. RESULTS: ASUC in-hospital mortality was 1.2% in 2008; 0.7% in 2010 (P = 0.22). Response to first-line steroid therapy was 61% (2008); 58% (2010) and mortality was higher in non-responders: 2008: 2.9% (9/315) vs. 0.19% (1/537; P < 0.001); 2010: 1.8% (7/391) vs. 0.0% (0/593; P = 0.002). In 2010, more patients (56%) received second-line medical therapy than in 2008 (47%, P = 0.02). In-hospital mortality was similar to second-line medical therapy vs. surgery without further medical therapy; 2008: 2.7% vs. 2.8%, P = 0.99; 2010: 0.9% vs. 3.1%, P = 0.17. Second-line therapy response was more frequently observed with anti-TNFα than ciclosporin: (2008: 76% vs. 46%, P < 0.001; 2010: 80% vs. 58%, P < 0.001). CONCLUSIONS: Mortality in acute severe ulcerative colitis was low, but higher in steroid non-responders. Patients treated with second-line medical therapies had no higher risk of in-hospital mortality than those undergoing surgery. Second-line 'rescue' medical therapy usage is increasing; however, ciclosporin response rates were relatively low.
BACKGROUND: Approximately one third of patients with acute severe ulcerative colitis (ASUC) fail response to steroids. Ciclosporin and anti-TNFα are proven second-line therapies, but evidence of their efficacy has come mainly from tertiary centres and/or selective clinical trial recruitment. AIM: To assess ASUC outcomes in a large unselected cohort. METHODS: UK-wide audits of IBD care were conducted in 2008 (209 hospital sites) and 2010 (198 hospital sites), covering >87% of admitting hospitals. Each site entered data from 20 consecutive UC admissions onto a web-based proforma. Admissions included 852 (2008) and 984 (2010) with ASUC, accounting for 35% and 39% of UC admissions, respectively. RESULTS: ASUC in-hospital mortality was 1.2% in 2008; 0.7% in 2010 (P = 0.22). Response to first-line steroid therapy was 61% (2008); 58% (2010) and mortality was higher in non-responders: 2008: 2.9% (9/315) vs. 0.19% (1/537; P < 0.001); 2010: 1.8% (7/391) vs. 0.0% (0/593; P = 0.002). In 2010, more patients (56%) received second-line medical therapy than in 2008 (47%, P = 0.02). In-hospital mortality was similar to second-line medical therapy vs. surgery without further medical therapy; 2008: 2.7% vs. 2.8%, P = 0.99; 2010: 0.9% vs. 3.1%, P = 0.17. Second-line therapy response was more frequently observed with anti-TNFα than ciclosporin: (2008: 76% vs. 46%, P < 0.001; 2010: 80% vs. 58%, P < 0.001). CONCLUSIONS: Mortality in acute severe ulcerative colitis was low, but higher in steroid non-responders. Patients treated with second-line medical therapies had no higher risk of in-hospital mortality than those undergoing surgery. Second-line 'rescue' medical therapy usage is increasing; however, ciclosporin response rates were relatively low.
Authors: Neeraj Narula; John K Marshall; Jean-Frederic Colombel; Grigorios I Leontiadis; John G Williams; Zack Muqtadir; Walter Reinisch Journal: Am J Gastroenterol Date: 2016-02-09 Impact factor: 10.864
Authors: Monica Cesarini; Gary S Collins; Anders Rönnblom; Antonieta Santos; Lai Mun Wang; Daniel Sjöberg; Miles Parkes; Satish Keshav; Simon P L Travis Journal: J Crohns Colitis Date: 2017-03-01 Impact factor: 9.071
Authors: Shaji Sebastian; Jessica Lisle; Sreedhar Subramanian; Anjan Dhar; Achut Shenoy; Jimmy Limdi; Jeffrey Butterworth; Patrick B Allen; Sunil Samuel; Gordon Moran; Richard Shenderey; Gareth Parkes; Tim Raine; Alan J Lobo; Nicholas A Kennedy Journal: Frontline Gastroenterol Date: 2019-08-17
Authors: Maryam Alkhatry; Ahmad Al-Rifai; Vito Annese; Filippos Georgopoulos; Ahmad N Jazzar; Ahmed M Khassouan; Zaher Koutoubi; Rahul Nathwani; Mazen S Taha; Jimmy K Limdi Journal: World J Gastroenterol Date: 2020-11-21 Impact factor: 5.742