Corticosteroids are a cornerstone in the treatment of a severe attack of ulcerative colitis.
The long-term prognosis in this patient group is not well described.
Dr Anders Gustavsson and colleagues from Sweden studied the long-term colectomy and relapse rates in patients given intensive intravenous corticosteroid treatment for acute ulcerative colitis.
|Colectomy rates were 9% with a moderately severe attack|
|The American Journal of Gastroenterology|
The team conducted a retrospective clinical study of 158 patients with ulcerative colitis treated between 1975 and 1982.
Patients were followed-up to death, colectomy or last visit.
The investigators assessed a total of 11 patients, were excluded due to change of diagnosis or lost to follow-up.
The team found the indication for index intensive intravenous corticosteroid treatment was a severe attack in 61 patients, and a moderately severe attack in 45 patients.
The investigators found that a mild attack occurred in 29 patients, and a chronic continuous disease in 12 patients.
The median duration of follow-up was 173 months in patients escaping colectomy during the first 3 months.
The team found 3 months after intensive intravenous corticosteroid treatment, colectomy rates were 46% with a severe attack.
Colectomy rates were 9% with a moderately severe attack, and 3% with mild attacks.
After 10 years, the colectomy rates were 64%, 49%, and 28%, for severe, moderately severe, and mild attacks, respectively.
During follow-up, colectomy incidence beyond 3 months was not influenced by severity of initial attack.
Time to first relapse nor relapse incidence was influenced by severity of initial attack, except for a lower relapse incidence after a severe attack.
Dr Gustavsson's team concluded, "In patients escaping colectomy during the first 3 months after intensive intravenous corticosteroid treatment, the future prognosis was similar irrespective of initial disease severity."