Year 2016 / Volume 108 / Number 11
Original
The use of a segmental endoscopic score may improve the prediction of clinical outcomes in acute severe ulcerative colitis

697-702

DOI: 10.17235/reed.2016.4470/2016

Samuel Raimundo Fernandes, Patrícia Santos, Carlos Miguel Moura, Pedro Marques da Costa, Joana Rita Carvalho, Ana Isabel Valente, Cilénia Baldaia, Ana Rita Gonçalves, Paula Moura Santos, Luís Araújo-Correia, José Velosa,

Abstract
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.
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Citation tools
Fernandes S, Santos P, Miguel Moura C, Marques da Costa P, Carvalho J, Isabel Valente A, et all. The use of a segmental endoscopic score may improve the prediction of clinical outcomes in acute severe ulcerative colitis. 4470/2016


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Publication history

Received: 26/05/2016

Accepted: 20/07/2016

Online First: 05/10/2016

Published: 02/11/2016

Article revision time: 48 days

Article Online First time: 132 days

Article editing time: 160 days


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