title: GI distension in severe ulcerative colitis.
abstract: OBJECTIVE
  In previous retrospective studies in patients with severe ulcerative colitis (UC), small bowel distension was found to characterize a subgroup of patients at higher risk for both toxic megacolon (TMC) and multiple organ dysfunction syndrome (MODS). In this study we prospectively evaluated the prevalence of GI distension and its relationship to clinical outcome in patients with severe UC.
  
  
  METHODS
  Of 109 consecutive inpatients with acute UC (admitted to the GI Unit of the University of Rome during the period 1995-2000), 45 had severe colitis. Routine blood tests and acid-base balance and plain abdominal film evaluations were performed upon admission and repeated every 1-3 days. The gas content of the stomach and small and large intestines was evaluated on plain abdominal films. All patients were submitted to the standard Oxford intensive medical regimen; clinical improvement, occurrence of major complications, need for surgery, and mortality were evaluated. Statistical analysis was carried out using Student's t, chi2, Fisher's exact, Mann-Whitney, and Wilcoxon rank sum tests, when appropriate.
  
  
  RESULTS
  Of 45 patients with severe UC, 24 (53%) had GI distension. Three of these 24 patients had TMC on admission (all underwent surgery and survived), 21 showed increased GI gas content (four developed TMC 1-4 days after the detection of GI distension and were operated on, two developed MODS and died, and eight did not improve but were submitted to surgery and survived). None of the 21 patients with normal GI gas content had complications; all survived (five did not improve and required surgery).
  
  
  CONCLUSIONS
  In severe UC, persistent GI distension characterized a subgroup of patients with poor response to medical therapy and at higher risk for TMC and of need for surgery. The development of MODS was the most important predicting factor for fatal outcome.
authors.affiliation: Gastroenterology Unit I, University La Sapienza, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Latella
authors.forename: Piero
authors.initials: P
authors.lastname: Vernia
authors.forename: Angelo
authors.initials: A
authors.lastname: Viscido
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Frieri
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Cadau
authors.forename: Andrea
authors.initials: A
authors.lastname: Cocco
authors.forename: Andrea
authors.initials: A
authors.lastname: Cossu
authors.forename: Ernesto
authors.initials: E
authors.lastname: Tomei
authors.forename: Renzo
authors.initials: R
authors.lastname: Caprilli
mesh_terms: D000328:Adult; D003093:Colitis, Ulcerative / Q000150:complications* / Q000000981:diagnostic imaging*; D004064:Digestive System / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D005740:Gases; D005767:Gastrointestinal Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008532:Megacolon, Toxic / Q000209:etiology* / Q000601:surgery; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D011860:Radiography, Abdominal; D011877:Radionuclide Imaging; D012720:Severity of Illness Index
chemical_list: D005740:Gases