Response to first intravenous steroid therapy determines the subsequent risk of colectomy in ulcerative colitis...

A severe flare-up develops in approximately 15% of patients with ulcerative colitis (UC). It is questionable whether the response to the first parenteral corticosteroid therapy decreases the risk for colectomy. Our aim was to evaluate the association between long-term colectomy rate and the efficacy of steroids in the first few days of the therapy and to assess other predictive factors for colectomy in our patients hospitalized because of the first severe attack of UC.

The records of the first hospitalization of a total of 183 UC patients with severe exacerbation were reviewed. Every patient had received parenteral corticosteroid treatment. Colectomy was performed in refractory UC or in the case of intolerable side-effects of the rescue therapy. We compared different laboratory and clinical parameters between patients undergoing colectomy and those who avoided surgery.

Clinical response to steroid therapy was achieved in 110 of the 183 patients with acute severe UC; 14.5% of steroid responder patients were operated on during the follow-up period. 39.7% of patients in the steroid-refractory group required either urgent or late colectomy. The overall colectomy rate was 24.6%. Unresponsiveness to intravenous steroid therapy, anemia, and the need for blood transfusion proved to be the major predictors for colectomy.

The colectomy rate was 2.5 times higher in our patients with acute severe UC not responding to the intensive steroid therapy, suggesting that the response to the therapy of the first 3-5 days of hospitalization may determine the long-term outcome and colectomy rate in UC.