Brief Article
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World J Gastroenterol. Jan 14, 2013; 19(2): 265-273
Published online Jan 14, 2013. doi: 10.3748/wjg.v19.i2.265
Clinical outcomes and predictive factors in oral corticosteroid-refractory active ulcerative colitis
Han Ho Jeon, Hyun Jung Lee, Hui Won Jang, Jin Young Yoon, Yoon Suk Jung, Soo Jung Park, Sung Pil Hong, Tae Il Kim, Won Ho Kim, Jae Hee Cheon
Han Ho Jeon, Hyun Jung Lee, Hui Won Jang, Jin Young Yoon, Yoon Suk Jung, Soo Jung Park, Sung Pil Hong, Tae Il Kim, Won Ho Kim, Jae Hee Cheon, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 120-752, South Korea
Won Ho Kim, Jae Hee Cheon, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul 120-752, South Korea
Author contributions: Jeon HH performed the data analysis and wrote the manuscript; Cheon JH had original idea on this subject, performed colonoscopy, performed the data analysis, and wrote the manuscript; Lee HJ, Jang HW, Yoon JY, Jung YS, Park SJ, Hong SP, Kim TI, and Kim WH performed colonoscopy and reviewed the manuscript critically.
Correspondence to: Jae Hee Cheon, MD, PhD, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea. geniushee@yuhs.ac
Telephone: +82-2-22281990 Fax: +82-2-3936884
Received: September 14, 2012
Revised: November 13, 2012
Accepted: November 24, 2012
Published online: January 14, 2013
Abstract

AIM: To evaluate the clinical outcomes and prognostic factors after intravenous corticosteroids following oral corticosteroid failure in active ulcerative colitis patients.

METHODS: Consecutive patients with moderate to severe ulcerative colitis who had been treated with a course of intravenous corticosteroids after oral corticosteroid therapy failure between January 1996 and July 2010 were recruited at Severance Hospital, Seoul, South Korea. The disease activity was measured by the Mayo score, which consists of stool frequency, rectal bleeding, mucosal appearance at flexible sigmoidoscopy, and Physician Global Assessment. We retrospectively evaluated clinical outcomes at two weeks, one month, three months, and one year after the initiation of intravenous corticosteroid therapy. Two weeks outcomes were classified as responders or non-responders. One month, three month and one year outcomes were classified into prolonged response, steroid dependency, and refractoriness.

RESULTS: Our study included a total of 67 eligible patients. At two weeks, 56 (83.6%) patients responded to intravenous corticosteroids. At one month, complete remission was documented in 18 (32.1%) patients and partial remission in 26 (46.4%). Eleven patients (19.7%) were refractory to the treatment. At three months and one year, we found 37 (67.3%) and 25 (46.3%) patients in prolonged response, ten (18.2%) and 23 (42.6%) patients in corticosteroid dependency, 8 (14.5%) and 6 (11.1%) patients with no response, respectively. Total 9 patients were underwent elective proctocolectomy within 1 year. The duration of oral corticosteroid therapy (> 14 d vs≤ 14 d, P = 0.049) and lower hemoglobin level (≤ 11.0 mg/dL vs >11.0 mg/dL, P = 0.02) were found to be poor prognostic factors for response at two weeks. For one year outcome, univariate analysis revealed that only a partial Mayo score (≥ 6 vs <6, P = 0.057) was found to be associated with a poor response.

CONCLUSION: The duration of oral corticosteroid therapy and lower hemoglobin level were strongly associated with poor outcome.

Keywords: Clinical outcome, Prognosis, Corticosteroid, Ulcerative colitis