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Long-term colectomy rate after intensive intravenous corticosteroid therapy for ulcerative colitis prior to the immunosuppressive treatment era
Örebro universitet, Hälsoakademin.
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2007 (Engelska)Ingår i: American Journal of Gastroenterology, ISSN 0002-9270, E-ISSN 1572-0241, Vol. 102, nr 11, s. 2513-2519Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

OBJECTIVES: Corticosteroids are a cornerstone in the treatment of a severe attack of ulcerative colitis (UC). The long-term prognosis in this patient group is not well described. We studied the long-term colectomy and relapse rates in patients given intensive intravenous corticosteroid treatment (IIVT) for acute UC. METHODS: A retrospective clinical study of 158 patients with UC treated in 1975-1982 with IIVT. Patients were followed-up to death, colectomy or last visit. RESULTS: A total of 11 patients were excluded due to change of diagnosis (N = 10) or lost to follow-up (N = 1). The indication for index IIVT in the remaining 147 patients was a severe attack (N = 61), a moderately severe attack (N = 45), a mild attack (N = 29) or chronic continuous disease (N = 12). The median (range) duration of follow-up was 173 (4-271) months in patients escaping colectomy during the first 3 months. Three months after IIVT, the colectomy rates were 28/61 (46%) in a severe attack, 4/45 (9%) in a moderately severe, and 1/29 (3%) in a mild attack. After 10 yr, the colectomy rates were 39/61 (64%), 22/45 (49%), and 8/29 (28%), respectively. During follow-up, neither colectomy incidence beyond 3 months, time to first relapse nor relapse incidence was influenced by severity of initial attack, except for a lower relapse incidence after a severe attack. CONCLUSIONS: In patients escaping colectomy during the first 3 months after IIVT, the future prognosis was similar irrespective of initial disease severity.

Ort, förlag, år, upplaga, sidor
New York: American College of Gastroenterology , 2007. Vol. 102, nr 11, s. 2513-2519
Nationell ämneskategori
Medicin och hälsovetenskap Gastroenterologi
Forskningsämne
Medicin
Identifikatorer
URN: urn:nbn:se:oru:diva-11550DOI: 10.1111/j.1572-0241.2007.01435.xPubMedID: 17680849OAI: oai:DiVA.org:oru-11550DiVA, id: diva2:343030
Tillgänglig från: 2010-08-11 Skapad: 2010-08-11 Senast uppdaterad: 2017-12-12Bibliografiskt granskad
Ingår i avhandling
1. Therapy in inflammatory bowel disease
Öppna denna publikation i ny flik eller fönster >>Therapy in inflammatory bowel disease
2012 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

The aim of this thesis is to study treatment of inflammatory bowel disease with respect to an acute severe attack of ulcerative colitis and endoscopic balloon dilation in stricturing Crohn’s disease.

A retrospective follow-up was made in 158 patients who were given intensive intravenous corticosteroid treatment due a severe, moderate, or mild attack of ulcerative colitis between 1975 and 1982. After 10 years, the colectomy frequency in the severe disease group was 64%, and 49% and28% in the moderate and mild groups, respectively. Severity of the original attack did not influence the subsequent clinical course with respect to colectomy.

In 2005, a controlled Swedish–Danish trial of infliximab as rescue therapy in an acute severe attack of steroid refractory ulcerative colitis showed that colectomy frequencies after 3 months were lower in infliximab-treated patients (29%) compared to placebo-treated patients (67%). After 3 years, a statistically significantly lower colectomy frequency remained in patients treated with infliximab (50%) compared to placebo (76%).

Between 1989 and 2009, 178 patients underwent endoscopic balloon dilation due to intestinal strictures in Crohn’s disease. Seventy-five patients,with a follow-up of 5 years or longer, underwent dilations due to symptomatic strictures only. After 5 years of follow-up, 39/75 (52%) of the patients had undergone no further intervention or one additional dilation only, and 36% had had surgery. The complication frequency was 5.3%, of which 10 patients (1.3%) required surgery. In 83 patients, we studied whether smoking at diagnosis affected the outcome after index dilation. In the group of active smokers, 31/32 (97%) underwent another intervention compared to 18/33 (55%) in never smokers (HR 2.18, 95% CI: 1.22-3.93,p = 0.01). Clinical parameters such as sex, age at diagnosis, age at first dilation, balloon size, localisation of stricture, treatment with azathioprine and treatment period did not influence outcome.

Ort, förlag, år, upplaga, sidor
Örebro: Örebro universitet, 2012. s. 97
Serie
Örebro Studies in Medicine, ISSN 1652-4063 ; 75
Nationell ämneskategori
Medicin och hälsovetenskap Gastroenterologi
Forskningsämne
Medicin
Identifikatorer
urn:nbn:se:oru:diva-25599 (URN)978-91-7668-897-7 (ISBN)
Disputation
2012-11-23, Wilandersalen, Universitetssjukhuset (USÖ), Örebro, 09:00 (Svenska)
Opponent
Tillgänglig från: 2012-08-30 Skapad: 2012-08-30 Senast uppdaterad: 2017-10-17Bibliografiskt granskad

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Gustavsson, AndersHalfvarson, JonasTysk, Curt

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