Background Intravenous steroid therapy is the main initial treatment for acute severe ulcerative colitis (ASUC). However, steroid dependence in patients who were treated with intravenous steroid therapy for ASUC is not fully evaluated. We aimed to determine the prevalence and risk factors of corticosteroid dependence after treatment of ASUC. Methods Adult patients who were admitted for the treatment of ASUC satisfying Truelove-Witts criteria from January 2015 to December 2020 were included in the study. Steroid dependence was defined as a failure to taper steroids below 10 mg within 3 months from initiating intravenous therapy or relapse within 3 months after steroid discontinuation. Results Among a total of 140 patients who received intravenous steroids as initial treatment for ASUC, 105 (75.0%) showed a response while 35 (25.0%) were refractory to steroids. Of 105 patients who responded to intravenous steroid therapy, 21 (20.0%) showed steroid dependence during the follow-period. Demographic and clinical variables were not significantly different between steroid-dependent and steroid response groups. However, initial C-reactive protein (CRP) levels in steroid-dependent groups were numerically lower compared with those in the steroid response group with statistical significance (4.4 ± 4.6 mg/dL versus 7.0 ± 6.4 mg/dL, p = 0.04). Conclusion A total of 20.0% of responders to intravenous steroid treatment for ASUC had a steroid dependency during follow-up. The demographic and clinical features of ASUC according to the presence or absence of steroid dependency were similar. Initial CRP levels were low in patients with steroid dependence.

Background Many patients with inflammatory bowel disease experience extra-intestinal manifestations (EIM)s. The presence of EIMs is related to disease activity. Acute severe ulcerative colitis (ASUC) is associated with a high inflammatory burden. However, there are insufficient studies on the relation between the presence of EIMs and the prognosis of exacerbation of ulcerative colitis. This study was conducted to elucidate the correlation between EIMs and ASUC. Methods We retrospectively included patients who were hospitalized at four tertiary medical centers for ASUC management between January 2015 to December 2020, and data on the underlying disease, disease activity, EIMs, colectomy, treatment method, and readmission due to ulcerative colitis aggravation were checked. Results A total of 145 patients (mean age 44.4 years, 68 women) were investigated. The initial partial Mayo score, the Mayo endoscopy sub-score, and the ulcerative colitis endoscopic severity index were 7.6±0.8%, 2.7±0.5, and 6.0±1.4%, respectively. EIMs were expressed in a total of 10.3% (15/145) of patients. The most common type of EIMs was the peripheral articular type (46.7%) followed by skin lesions (20%) and axial articular disease (13.3%). The group with EIMs was younger and had a higher proportion of women than the group without EIMs (39.4 versus 45 years, p=0.03), and had a longer duration of disease (5.8 versus 3.5 years, p=0.02). The Mayo endoscopic sub-score (2.9 vs. 2.7, p<0.01) and partial endoscopic score (7.9 vs. 7.6, p<0.01) were also higher in the EIMs group. The length of hospital stay was also longer in the EIMs group (25.5 days vs. 13.8 days, p<0.01). The response rate to initial treatment was lower in the EIMs group (71.4% vs. 95.5%, p<0.01), and more rescue therapy (28.6% vs. 4.5%, p<0.01) was performed. The rate of colectomy on admission was also higher in the group with EIMs (13.3% vs. 0.8%, p<0.01). Patients with EIMs showed a high tendency to visit the hospital for re-exacerbation of ulcerative colitis after discharge (p=0.07, HR 2.10 CI: 0.93 – 4.76). Conclusion EIMs were expressed in a total of 10.3% of patients with ASUC. The presence of EIMs suggested a poor prognosis in ASUC.

Background There are insufficient studies on clinical outcome after surveillance of low grade dysplasia (LGD) in patients with inflammatory bowel disease (IBD). We aimed to evaluate the clinical feature, frequency and risk factors of advanced neoplasia in IBD patients after diagnosis of LGD Methods From 2003 to 2020, medical records of 166 IBD patients from 6 university hospitals in Korea were reviewed retrospectively. All of the patients were diagnosed as LGD in surveillance. Patents’ baseline characteristics, disease status, polyp characteristics and treatment were evaluated. The frequency and risk factors of advanced neoplasia were also analyzed. Results Disease duration was 11.47 years (7.85-14.50), and follow-up duration was 3.74 years (1.95-7.58). Colitis associated LGD was noted in 56 cases (33.7%), Advanced neoplasia developed in 12 cases (6 large LGD, 3 tubulovillous adenoma, 3 high grade dysplasia) and all the cases developed from UC. Patients with advanced neoplasia had significantly higher Mayo score and colitis-related dysplasia were more common than sporadic lesions (83.3% vs. 29.9%; P<0.001). In multivariate analysis, colitis-associated LGD significantly increased the risk of developing advanced neoplasia (Odds ratio [OR], 10.516; 95% confidence interval [CI], 2.064-53.577; P=0.005). Among patients with colitis-associated lesions, a significant risk factor for advanced neoplasia was a history of LGD (OR, 9.429; 95% CI, 1.330-66.863; P=0.025). Conclusion Advanced neoplasia developed in 7.2% of IBD patients with LGD. Because most of advanced neoplasia developed from colitis-associated lesions, more careful examination is suggested in patients with colitis -associated LGD, especially with previous history, in surveillance colonoscopy.

Background Biologics such as infliximab is the main treatment for steroid refractory acute severe ulcerative colitis (ASUC), However, there are only a few studies on the effectiveness and safety of biologics in steroid refractory ASUC. In this study, we evaluated the effectiveness and safety of biologics as a rescue therapy for biologics naïve steroid refractory ASUC patient in Korea. Methods We retrospectively included patients who were hospitalized at seven tertiary medical centers for ASUC management between January 2015 to December 2020, and data on the demographic and clinical variables, disease activity, treatment method, treatment response, adverse event, readmission due to any reasons were checked Results A total of 230 ASUC patients were included, of which 220 were biologic naïve patient. The response rate of steroid in these patients was 74%, and infliximab was administered as rescue therapy to 53 patients who failed initial steroid treatment. The response rate to infliximab as rescue therapy was 96%, and 2 patients who did not respond received colectomy. One of the two patients who underwent colectomy died of sepsis. There was no infliximab-related adverse event during hospitalization. Although infliximab itself was not a factor associated with infection after discharge (10% vs. 16%, p=0.355), combination therapy with thiopurine was a risk factor for infection after discharge. (Odd ratio 7.302, 95% CI 2.101-25.372, p=0.002). A total of 12 infections occurred in patients treated with infliximab after discharge (3 pneumonia, 1 skin infection, 3 cytomegalovirus colitis, 4 Clostridium difficile infection) and were associated with readmission. (40.1% vs. 75%, p=0.031) Conclusion As a rescue therapy in biologics naive steroid refractory ASUC, infliximab showed a 96% therapeutic response. Although infliximab itself did not increase the risk of infection after discharge, the combination with thiopurine increased the risk of infection after discharge