Clinical spectrum of acute severe ulcerative colitis in the biologic era: a prospective cohort study from India.

IF 3.4 Q2 GASTROENTEROLOGY & HEPATOLOGY

Intestinal Research Pub Date : 2025-06-09 DOI:10.5217/ir.2024.00189

Arshdeep Singh, Mayur Luthra, Arshia Bhardwaj, Ramit Mahajan, Riya Sharma, Dharmatma Singh, Devanshi Jain, Omesh Goyal, Varun Mehta, Kirandeep Kaur, Yogesh Kumar Gupta, Vandana Midha, Ajit Sood

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引用次数: 0

Abstract

Background/aims: Acute severe ulcerative colitis (ASUC) is a time-critical situation requiring urgent intervention. Limited data exist on the evolving clinical spectrum of ASUC in the era of advanced therapies.

Methods: This prospective real-world observational cohort study included 145 adult patients hospitalized with ASUC between January 2020 and June 2024. ASUC was defined by the modified Truelove and Witts criteria. Demographics and disease characteristics, including disease severity, probable precipitating factors, and corticosteroid failure rates, were recorded.

Results: The median age of patients was 36 years (interquartile range, 26-48.5 years) with 63 females (43.4%). Most patients had left-sided colitis (53.1%). The median disease duration was 1 year (IQR, 0.5-3 years), with 91 patients (62.7%) presenting with ASUC within the first year of diagnosis of ulcerative colitis. One-third of the patients had previous exposure to biologics and small molecules. The most commonly reported probable precipitants of ASUC were poor compliance with treatment (n = 43, 29.6%), antibiotic use (n = 35, 24.1%), high perceived stress (n = 32, 22.1%), and Clostridioides difficile infection (n = 19, 13.1%). Forty patients (27.5%) were non-responders to intravenous corticosteroids (IVCS). Twenty-nine patients (20%) received medical rescue therapy (infliximab, n = 14 [48.27%], cyclosporine A, n = 6 [20.68%], and tofacitinib, n = 9 [31.03%]). Seven patients (4.82%; 4 after non-response to IVCS and 3 after non-response to medical rescue therapy) underwent colectomy.

Conclusions: In this cohort of ASUC patients, poor treatment compliance, antibiotic use, stress, and C. difficile infection were common precipitants of flare-ups. Nearly one-third of patients required medical rescue therapy, and a small proportion ultimately underwent colectomy.

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生物时代急性严重溃疡性结肠炎的临床谱：一项来自印度的前瞻性队列研究。

背景/目的：急性严重溃疡性结肠炎（ASUC）是一种时间紧迫的情况，需要紧急干预。在先进治疗的时代，关于ASUC临床谱的数据有限。方法：这项前瞻性现实世界观察队列研究包括145名在2020年1月至2024年6月期间住院的ASUC成年患者。ASUC由修改后的Truelove和Witts标准定义。记录人口统计学和疾病特征，包括疾病严重程度、可能的诱发因素和皮质类固醇失败率。结果：患者中位年龄36岁（四分位数范围26 ~ 48.5岁），其中女性63例（43.4%）。大多数患者为左侧结肠炎（53.1%）。中位病程为1年（IQR， 0.5-3年），91例（62.7%）患者在诊断为溃疡性结肠炎的一年内出现ASUC。三分之一的患者曾接触过生物制剂和小分子药物。最常报道的ASUC可能的沉淀因素是治疗依从性差（n = 43, 29.6%）、抗生素使用（n = 35, 24.1%）、高感知应激（n = 32, 22.1%）和艰难梭菌感染（n = 19, 13.1%）。40例（27.5%）患者对静脉注射皮质类固醇（IVCS）无反应。29例（20%）患者接受医学抢救治疗（英夫利昔单抗14例[48.27%]，环孢素A 6例[20.68%]，托法替尼9例[31.03%]）。7例（4.82%）；4例IVCS无效，3例医学抢救治疗无效)行结肠切除术。结论：在这组ASUC患者中，治疗依从性差、抗生素使用、压力和艰难梭菌感染是急性发作的常见诱因。近三分之一的患者需要医疗救助治疗，一小部分患者最终接受了结肠切除术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Intestinal Research GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

7.40

自引率

10.20%

发文量

审稿时长

38 weeks

期刊介绍： Intestinal Research (Intest Res) is the joint official publication of the Asian Organization for Crohn''s and Colitis (AOCC), Chinese Society of IBD (CSIBD), Japanese Society for IBD (JSIBD), Korean Association for the Study of Intestinal Diseases (KASID), Taiwan Society of IBD (TSIBD) and Colitis Crohn''s Foundation (India) (CCF, india). The aim of the Journal is to provide broad and in-depth analysis of intestinal diseases, especially inflammatory bowel disease, which shows increasing tendency and significance. As a Journal specialized in clinical and translational research in gastroenterology, it encompasses multiple aspects of diseases originated from the small and large intestines. The Journal also seeks to propagate and exchange useful innovations, both in ideas and in practice, within the research community. As a mode of scholarly communication, it encourages scientific investigation through the rigorous peer-review system and constitutes a qualified and continual platform for sharing studies of researchers and practitioners. Specifically, the Journal presents up-to-date coverage of medical researches on the physiology, epidemiology, pathophysiology, clinical presentations, and therapeutic interventions of the intestinal diseases. General topics of interest include inflammatory bowel disease, colon and small intestine cancer or polyp, endoscopy, irritable bowel syndrome and other motility disorders, infectious enterocolitis, intestinal tuberculosis, and so forth. The Journal publishes diverse types of academic materials such as editorials, clinical and basic reviews, original articles, case reports, letters to the editor, brief communications, perspective, statement or commentary, and images that are useful to clinicians and researchers.