An audit of the immunosuppressive management of ulcerative colitis. A retrospective chart review from a referral Day-Hospital of Gastro-enterology.
BACKGROUND
Ulcerative colitis is a chronic inflammatory disease of the colon thought to be caused by an abnormal T-cell response to lumenal antigens. In the last 10 years immunosuppressives have been proposed to treat its severe forms including cyclosporin and azathioprine.


METHODS
An analysis of 72 patients treated for severe ulcerative colitis between 1991 and 2001 at our Day Hospital permitted an audit of the efficacy of this two-drug regime.


RESULTS
Overall, the percentages of patients avoiding colectomy immediately, at 1 year, and on ending the study were 68, 47 and 36%, respectively. Thirty-five (81%) of the 43 colectomies, performed as a restorative procedure, clustered in the first year after disease presentation. The risk of colectomy was significantly reduced in the subset treated with azathioprine. Of the 25 long-term responder patients avoiding colectomy, to-date 16 (64%) had at least a relapse at the median time of 17.5 months; all but 1 episodes were managed on an out-patient basis. The types and frequencies of observed side-effects were within the known therapeutic profile of the two drugs.


CONCLUSIONS
A two-drug regime of cyclosporin and azathioprine can avoid colectomy for 1 year in slightly less than 50% of a cohort of severe ulcerative colitis patients and permits an acceptable long-term response in slightly less than 40%. An accurate evaluation of this policy needs to be balanced with other options, including most recently refined techniques of colectomy.
Division of Gastroenterology, Molinette Hospital, Turin.
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Actis
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Pinna-Pintor