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Multiple organ dysfunction in ulcerative colitis.

R Caprilli1, G Latella, P Vernia

  • 1Dipartimento di Scienze Cliniche, 1a Cattedra di Gastroenterologia, Università di Roma La Sapienza, Italy.

The American Journal of Gastroenterology
|May 16, 2000
PubMed
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Severe ulcerative colitis (UC) can lead to multiple organ dysfunction syndrome (MODS), a significant cause of mortality. Early recognition and intensive care are crucial for managing this severe complication of UC.

Area of Science:

  • Gastroenterology
  • Critical Care Medicine
  • Internal Medicine

Background:

  • Severe ulcerative colitis (UC) mortality is typically linked to colonic issues or surgery.
  • Multiple organ dysfunction syndrome (MODS) is a severe complication of critical illnesses with high mortality.
  • MODS has not been previously reported as a complication of UC.

Purpose of the Study:

  • To investigate the prevalence of MODS in patients with severe UC.
  • To determine the outcome of severe UC patients who develop MODS.

Main Methods:

  • Retrospective analysis of 180 severe UC patients (1976-1998).
  • UC severity assessed by Truelove and Witts criteria.
  • MODS defined by American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference 1992 criteria.

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  • Standard intensive treatment included total parenteral nutrition and hydrocortisone; colectomy followed the Oxford intensive regimen.

    • Main Results:

    • 11 out of 180 (6.1%) severe UC patients developed MODS.
    • Most common organ involvement included liver (7), lung (5), and kidney (3).
    • MODS occurred in conjunction with toxic megacolon (5) or impending megacolon (4).
    • MODS was present in 8 of the 12 (72.7%) fatal cases, indicating a high mortality impact.

    Conclusions:

    • Ulcerative colitis should be recognized as a potential cause of MODS.
    • MODS was the primary cause of death in the majority of fatal severe UC cases at this center.
    • Prompt identification of MODS signs necessitates intensive care unit admission and urgent surgical intervention.