title: Operative indications for patients with refractory or severe ulcerative colitis.
abstract: OBJECTIVE
  The failure of medical treatment for severe ulcerative colitis (UC) can result in an emergency colectomy. Since new treatments using cyclosporin A and leukocytapheresis have been developed, we analyzed historical changes in the operative indications for UC.
  
  
  METHODS
  We retrospectively reviewed the medical record of 40 patients who underwent surgery, and analyzed the medical treatments before surgery using two groups (urgent and elective) and two time periods (1986-1999, 2000-2003).
  
  
  RESULTS
  The number of patients who received operations in the severe UC group from 1986 to 1999 was 17 out of 23 patients, but this number decreased from 2000 to 2003. Although 40% of the patients from 2000 to 2003 in the refractory UC group had been treated with steroids only, the mean times of high-dose steroid therapy decreased from 4.3 to 2.5. The total amount of steroids administered in both groups tended to decrease from 2000 onwards. The postoperative questionnaire indicated that about half of them felt that their surgery had been performed too late.
  
  
  CONCLUSIONS
  The number of emergency colectomies for severe UC has been decreasing with the introduction of new therapies, but gastroenterologists should carefully monitor the potentially adverse effects of steroids for refractory UC.
authors.affiliation: Division of Gastroenterology, Shiga University of Medical Science, Shiga, Japan. tujikawa@belle.shiga-med.ac.jp
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Tsujikawa
authors.forename: Akira
authors.initials: A
authors.lastname: Andoh
authors.forename: Masaya
authors.initials: M
authors.lastname: Sakaki
authors.forename: Izumi
authors.initials: I
authors.lastname: Ishizuka
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Araki
authors.forename: Shigeki
authors.initials: S
authors.lastname: Koyama
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Fujiyama
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D002648:Child; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000601:surgery*; D017558:Elective Surgical Procedures; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D017211:Treatment Failure