title: Short term colectomy rate and mortality for severe ulcerative colitis in the last 40 years. Has something changed?
abstract: BACKGROUND
  About 20% of ulcerative colitis patients will experience a severe attack during the course of the disease. Intensive treatment, early surgery and, more recently, "rescue therapies" improved prognosis.
  
  
  OBJECTIVE
  To evaluate in-hospital colectomy and mortality rates for severe ulcerative colitis over 40 years in two referral centres.
  
  
  METHODS
  All in-patients with severe ulcerative colitis from 1976 to 2010 were considered. 159 patients were assigned to 4 cohorts: cohort 1 n=34 (1976-1980); cohort 2 n=29 (1986-1990); cohort 3 n=45 (1996-2000); cohort 4 n=51 (2006-2010).
  
  
  RESULTS
  The colectomy rate was 64.7%, 62.0%, 44.4% and 9.8%, respectively, in the four cohorts (p<0.0001). The mortality rate decreased from 8.8% in cohort 1, to 0 in cohort 4 (p=0.04). Infliximab was used only in cohort 4 (17 patients).
  
  
  CONCLUSIONS
  A significant reduction of colectomy and mortality rates in severe ulcerative colitis was observed in the last 40 years. Better management of patients, reduced attitude to operate severe ulcerative colitis, as well as the use of Infliximab in the last cohort, all could have contributed to the improved outcome.
authors: Gastroenterology Unit of Department of Internal Medicine and Medical Specialties of "Sapienza", University of Rome, Italy. Electronic address: valeclem@yahoo.it.
authors: Valeria
authors: V
authors: Clemente
authors: Gastroenterology and Hepatology Unit of "San Filippo Neri" Hospital of Rome, Italy.
authors: Annalisa
authors: A
authors: Aratari
authors: Gastroenterology and Hepatology Unit of "San Filippo Neri" Hospital of Rome, Italy.
authors: Claudio
authors: C
authors: Papi
authors: Gastroenterology Unit of Department of Internal Medicine and Medical Specialties of "Sapienza", University of Rome, Italy.
authors: Piero
authors: P
authors: Vernia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003082:Colectomy / Q000706:statistics & numerical data* / Q000639:trends; D003093:Colitis, Ulcerative / Q000401:mortality* / Q000628:therapy*; D019468:Disease Management; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use*; D007558:Italy; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005765:Gastrointestinal Agents; D000069285:Infliximab
keywords: Colectomy; Mortality; Severe ulcerative colitis