[Frequency and predictive factors of colectomy and restorative colo-proctectomy in ulcerative colitis].
OBJECTIVE
To determine the frequency and the predictive factors of colectomy and restorative colo-proctectomy in patients with ulcerative colitis.


METHODS
We conducted an 11-year retrospective study based on hospitalized ulcerative colitis patients followed up for more than 6 months.


RESULTS
From 1995 to 2005, 115 patients were included (50 men, 65 women, mean age: 38.4 years). Mean duration of follow-up was 39.2 months (6 - 145). Colectomy was performed in 20 patients (17%), with an actuarial risk of 16% at 5 years and 35% at 10 years. Proctocolectomy with ileoanal anastomosis was performed in 16 cases and total colectomy with ileorectal anastomosis in 4 cases. In univariate analysis, factors associated with an increased risk of colectomy were pancolitic location (p = 02), acute severe colitis (p < 0.0001), treatment by intravenous corticosteroids (p < 0.0001) and intravenous cyclosporine (p = 0.001). In multivariate analysis, acute severe colitis was the only independent factor associated with colectomy (p = 0.04 OR [CI 95%] :6.66 [1.04 - 50]). In patients with distal location, the independent factor associated with colectomy was colonic extension during follow up (p = 0.04 OR [CI 95%] :7.69 [1.07 - 50]). In patients with pancolitic location, risk of colectomy was associated with acute severe colitis (p = 0.01 OR [CI 95%] :9.09 [1.58 - 50]) and years of hospitalization from 1995 to 1999 (p = 0.02 OR [CI 95%] :7.14 [1.35 - 44]).


CONCLUSIONS
Although the diffusion of treatment by intravenous cyclosporin, surgery is frequently performed in our ulcerative colitis patients, specially in case of acute severe colitis. Evaluation of colonic extension during the follow-up is associated with an important prognostic impact.
Karoui
Sami
S
Service de Gastro-entérologie A. Hôpital la Rabta, Tunis.
Serghini
Meriem
M
Chaieb
Mona
M
Jomni
Taieb
T
Kallel
Lamia
L
Fekih
Monia
M
Matri
Samira
S
Boubaker
Jalel
J
Filali
Azza
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D003082:Colectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*; D003524:Cyclosporins / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016737:Proctocolectomy, Restorative / Q000379:methods; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome; D014416:Tunisia / Q000453:epidemiology
D003524:Cyclosporins; D005938:Glucocorticoids; D007166:Immunosuppressive Agents