Prognosis of severe attacks in ulcerative colitis: effect of intensive medical treatment

Rapid endoscopic improvement is important for 1-year avoidance of colectomy but not for the long-term prognosis in cyclosporine A treatment for ulcerative colitis

“…Our study showed that 73.6% of patients initially responded, but 54.4% of patients required colectomy at 11 years. Either short-term or long-term prognosis is consistent with most previous reports [9,[15][16][17]. We evaluated the long-term prognosis by focusing on the necessity/avoidance of colectomy.…”

“…In previous studies, predictive factors for the prognosis were often determined by evaluating the overall risk of surgery including both immediate and late colectomy [9,15,16]. However, from our experience in the clinical setting, we believe that induction and maintenance therapies should be discussed separately.…”

Guidelines for the management of ulcerative colitis. Recommendations of the Working Group of the Polish National Consultant in Gastroenterology and the Polish Society of Gastroenterology

“…Nie są dobrze zdefiniowane czynniki ryzyka nieskuteczności postępowania zachowawczego w leczeniu ciężkiego rzutu WZJG. Dotychczas przeprowadzone badania pokazują m.in., że duże wartości OB i temperatura powyżej 38°C w dniu przyjęcia, a także powyżej 8 wypróżnień na dobę lub duże stężenie CRP (> 45 mg/l) i 3-8 wypróżnień na dobę w 3. dniu steroidoterapii wiążą się z dużym prawdopodobieństwem konieczności leczenia chirurgicznego na kolejnym etapie terapii [7,64,65]. Odraczanie leczenia operacyjnego pomimo nieskuteczności farmakoterapii jest częstym błędem w leczeniu chorych z ciężkim rzutem WZJG.…”

Infliximab to treat severe ulcerative colitis

“…In cases of ulcerative colitis, the symptoms used to determine whether an individual is refractory to treatment include fever, diarrhea three or more times per day, bleeding, and fecal urgency [3] . Immunomodulators, such as azathioprine, have been used as adjuvant therapy in patients with ulcerative colitis who are classified as nonresponders to oral steroids, the recommended initial dose being 2 mg/kg per day, which can be gradually increased if a satisfactory response is not achieved [4] .…”

“…She had a white blood cell count of 161 000/mm 3 , hematocrit of 13%, hemoglobin of 5.0 g/dL, erythrocyte sedimentation rate of 130 mm in the first hour, C-reactive protein of > 5 mg/dL, iron of 10 mg/dL, albumin of 2 g/dL, and alpha 1-acid glycoprotein of 230 mg/dL. A colonoscopy revealed severe ulcerative colitis extending from the rectum (Figure 1).…”