P0361 Clinical outcomes of acute severe colitis in Latin American: a case series
Authors: Burmann B P , Barros L L , Romero A E P , Salgado J G D , Prado R D C P , Mattos P S L D , Azevedo M F C D , Carlos A D S , Damião A O M C 
Published: January 2025

Background

Acute severe ulcerative colitis (ASUC) is a potentially life-threatening complication of ulcerative colitis (UC), affecting up to 25% of patients throughout the course of the disease. Although it typically presents as an acute exacerbation of a chronic condition, ASUC can also be the initial manifestation of UC in up to one-third of patients. It is regarded as a clinical emergency, and in some cases, a surgical emergency due to the high risk of progression to colectomy. Optimal management of ASUC requires hospitalization and the involvement of a multidisciplinary team.

Methods

Medical records were queried using informatics tool to identify patients with ICD-9/10 code for CD and clinical terms associated with ASUC and UC between January 2014 and January 2024. Data on demographics, IBD phenotype, clinical and endoscopic activity, medical treatment and surgical procedures were obtained. The diagnosis of ASUC was established according to the Truelove and Witts criteria.

Results

A total of 41 patients with UC developed ASUC. According to the Montreal classification, 19 (61%) patients had pancolitis and 20 (60%) of them were diagnosed between 17 and 40 years old. In the studied case series, 26 (63.4%) were female and 26 (66.7%) were non-smokers. Additionally, more than half of the patients (58.3%) presented with extraintestinal manifestations. During the course of ASUC, nearly all patients received corticosteroid therapy (91,7%), 14(41%) required rescue therapy and 17 (41.5%) patients underwent colectomy. In this cohort, over 70% of patients experienced surgical complications and 11 (29.7%) were admitted to the intensive care unit. Lower hemoglobin levels at admission were identified as an independent risk factor for ICU admission, with each 1 g/dL increase reducing the risk by 53% (p &lt; 0.05). Eleven patients (26.8%) required hospital readmission due to a recurrence of ASUC, none of whom had undergone colectomy during the prior hospitalization (p &lt; 0.05).

Conclusion

Our findings indicate a high burden of ASUC in Latin America. Despite medical management, a significant proportion of patients required rescue therapy or surgical intervention, with a notable incidence of postoperative complications and ICU admissions. The high readmission rate highlights the need for improved long-term management strategies to reduce recurrence and enhance patient outcomes.

References

1.Quaresma AB, Damiao AOMC, Coy CSR, Magro DO, Hino AAF, Valverde DA, Panaccione R, Coward SB, Ng SC, Kaplan GG, Kotze PG. Temporal trends in the epidemiology of inflammatory bowel diseases in the public healthcare system in Brazil: A large population-based study. Lancet Reg Health Am. 2022 Jun 9;13:100298.

2.Rivière P, Li Wai Suen C, Chaparro M, De Cruz P, Spinelli A, Laharie D. Acute severe ulcerative colitis management: unanswered questions and latest insights. Lancet Gastroenterol Hepatol. 2024 Mar;9(3):251-262.