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

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

Revista Española de Enfermedades Digestivas, January 2016

27701881

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

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. 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. 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. 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.