The use of a segmental endoscopic score may improve the prediction of clinical outcomes in acute severe ulcerative colitis

• Samuel Raimundo Fernandes ^[1] ; Patrícia Santos ^[1] ; Carlos Miguel Moura ^[1] ; Pedro Marques da Costa ^[1] ; Joana Rita Carvalho ^[1] ; Ana Isabel Valente ^[1] ; Cilénia Baldaia ^[1] ; Ana Rita Gonçalves ^[1] ; Paula Moura Santos ^[1] ; Luís Araújo-Correia ^[1] ; José Velosa ^[1]
  1. [1] Centro Hospitalar Lisboa Norte

     Centro Hospitalar Lisboa Norte

     Socorro, Portugal

     
• Localización: Revista Española de Enfermedades Digestivas, ISSN-e 2340-4167, ISSN 1130-0108, Vol. 108, Nº. 11, 2016, págs. 697-702
• Idioma: inglés
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• Resumen

  • Background: Acute severe colitis (ASC) remains a challenging complication of ulcerative colitis. The early identification of patients who will not respond to optimal therapy is warranted. Increasing evidence suggests that endoscopy may play a role in predicting important outcomes in acute severe colitis.

    Methods: The endoscopic activity of consecutive patients with acute severe colitis was evaluated using the Mayo endoscopic sub-score (Mayo) and the ulcerative colitis endoscopic index of severity (UCEIS).

    Two segmental indexes were also produced by summing the scores of the rectum and sigmoid (seg-Mayo and seg-UCEIS, respectively).

    Endpoints included the need for salvage therapy with infliximab or cyclosporine, refractoriness to corticosteroids, and colectomy.

    Results: Of one hundred and eight patients enrolled in the study, 60 (55.6%) were male; with a median age of 34.5 years (range 15-80). All patients received intravenous steroids. Fifty-nine patients (55.6%) showed an incomplete or absent response to steroids, 35 patients (34.3%) received salvage therapy with infliximab or cyclosporine and 38 patients (33.3%) were colectomized during the index hospitalization or within the first year of follow-up. All scores were able to predict the need for surgery, but only the seg-UCEIS significantly predicted refractoriness to steroids.

    Conclusions: There was a strong correlation between endoscopic severity and unfavorable outcomes. The UCEIS outperformed the Mayo endoscopic sub-score in all important outcomes. Segmental scoring further improved the performance of the UCEIS.