Abstract
Background and Aims: Treatment with intravenous corticosteroids (IVCS) is a mainstay in the management of acute severe ulcerative colitis (UC). Although most patients respond to IVCS, little is known about the long-term outcomes. In this study, we assessed the long-term outcomes of IVCS in a real-life cohort. Methods: Disease activity, clinical relapse (partial Mayo score >4), the need for steroids or other maintenance therapies and the rates of colectomy and re-hospitalization were evaluated in consecutive patients admitted to the Tor Vergata University hospital between 2010 and 2020 for acute severe UC who responded to IVCS. Results: Eighty-eight patients were followed up with for a median period of 46 (range 6–133) months. Of these, 56 (64%) patients were treated with 5-aminosalycilic acid and 32 (36%) with immunomodulators or biologics after discharge. A total of 60 out of 88 patients (68%) relapsed, 28 (32%) were re-hospitalized, and 15 (17%) underwent a colectomy with no difference between the two maintenance therapy groups. The multivariate analysis showed that patients in clinical remission 6 months after discharge had a lower risk of relapse during the follow-up. Conclusions: Nearly two-thirds of patients with acute UC responding to IVCS experienced relapse after a median follow-up of 4 years, and this was not influenced by the maintenance therapy.
Highlights
Ulcerative colitis (UC) is a chronic immune-mediated disorder of the gastrointestinal tract of unknown etiology in which inflammation starting from the rectum can extend proximally and involve the whole colon [1]
Study Population and Data Collection. This retrospective study included all patients with established ulcerative colitis (UC) diagnosis admitted to the Tor Vergata University hospital between 2010 and 2020 for severe relapse who were successfully treated with intravenous corticosteroids (IVCS)
Hospitalization was due to the first severe exacerbation of colitis and, all the patients received the first course of IVCS treatment
Summary
Ulcerative colitis (UC) is a chronic immune-mediated disorder of the gastrointestinal tract of unknown etiology in which inflammation starting from the rectum can extend proximally and involve the whole colon [1]. Acute severe UC is a life-threatening condition, which requires hospitalization of the patients [4,5]. The cornerstone of acute severe UC treatment remains intravenous corticosteroids (IVCS), the use of which, together with fluid and electrolyte resuscitation, nutritional support, and thromboprophylaxis, has significantly decreased mortality among this subgroup of patients [6,7]. Treatment with intravenous corticosteroids (IVCS) is a mainstay in the management of acute severe ulcerative colitis (UC). Most patients respond to IVCS, little is known about the long-term outcomes. Methods: Disease activity, clinical relapse (partial Mayo score >4), the need for steroids or other maintenance therapies and the rates of colectomy and re-hospitalization were evaluated in consecutive patients admitted to the Tor Vergata University hospital between 2010 and 2020 for acute severe UC who responded to IVCS.
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