Lynch RW, Lowe D, Protheroe A et al. Aliment Pharmacol Ther 2013;38:935–45.
This national UK study reported the clinical outcomes of individuals admitted to hospital with acute, severe ulcerative colitis in 2008 and 2010.
The UK IBD audit is a UK national gastrointestinal audit that has collected data from over 90% of trusts or health boards in the UK that admit IBD patients (approximately 200 hospitals). Each participating audit site was asked to collect data on 40 consecutive admissions (20 Crohn’s disease and 20 ulcerative colitis [UC] patients) to their site in 2008 and 2010. This particular article focused on hospital cases of acute, severe UC (ASUC), a medical emergency with significant mortality if inappropriately managed. This dataset provides an invaluable “real-life” overview of ASUC (in total, 852 cases). Key findings from this audit include a low in-patient mortality rate (approximately 1%) at both assessment points. In-patient mortality was higher in non-responders to medical therapy, and there was a remarkably consistent rate of failure to intravenous steroids (of 40%) at the two time-points. Of interest, in-hospital mortality was similar between patients who received second-line medical therapy and those who underwent surgery without further medical therapy at both assessments. It is noted that the response to second-line therapy was more frequently observed with anti-tumor necrosis factor (anti-TNF) treatment than with cyclosporine (in 2008, 76% vs. 46%, p<0.001; in 2010, 80% vs. 58%, p<0.001). In this study, the definition of response to rescue medical therapy was classified as being discharged from hospital without surgery or additional rescue medical therapy. This differed from the multiple-endpoint definition used in a recent article by Laharie et al. comparing cyclosporine and anti-TNF in ASUC, in which no difference between these two second-line therapies was observed . Colectomy rates within the ASUC population in both audit rounds, 19% in 2008 and 17% in 2010, were lower than the rate of 27% observed in a meta-analysis performed by Turner et al. . The authors suggest that this disparity might be due to the more frequent use of cyclosporine and anti-TNF agents as second-line medical therapies in recent times.