Colectomy is a potentially life-saving procedure for patients with severe attacks of ulcerative colitis who fail medical therapy.
Dr Dan Turner and colleagues from Canada systematically reviewed studies that reported the short-term colectomy rate in severe ulcerative colitis or reported variables that could predict treatment failure.
The doctors conducted a systematic literature search for cohort studies and controlled trials published between 1974 and 2006.
The team of doctors found 32 studies that met the inclusion criteria.
Of these, 16 reported short-term outcome and predictors of therapy failure, 13 only outcomes, and 3 only predictors.
|Cyclosporine had a 51% short-term success rate|
|Clinical Gastroenterology & Hepatology|
In the pooled analysis, 581 of 1991 patients required colectomy, and 22 died.
The doctors found that in a heterogeneity-controlled meta-regression, colectomy rate did not change during the last 30 years.
Cyclosporine was used in only 100 patients, with a 51% short-term success rate.
Using a second meta-regression, the team failed to demonstrate a dose-colectomy response of methylprednisolone therapy beyond 60 mg daily.
The doctors identified more than 20 variables in 19 studies to predict medical therapy failure.
Only a few were consistently reproduced such as disease extent, stool frequency, temperature, heart rate, C-reactive protein, albumin, and radiologic assessment.
Dr Turner's team commented, “The short-term colectomy rate in severe ulcerative colitis has remained stable during the last 30 years, despite the introduction of cyclosporine, which was not used frequently.”
“We could not find any support for administering methylprednisolone at a higher dose than 60 mg/day.”
“Variables that predict outcome of corticosteroid therapy could aid in the development of guidelines for introduction of rescue therapies in severe ulcerative colitis.”