Dergiler / Turkish Journal of Gastroenterology / 2000 / Cilt: 11 - Sayı: 3
Is determination of initial attack severity predictive for long-term prognosis in patients with total ulcerative colitis?
- Sayfa
- 231–234
- DOI
- —
Özet
Amaç: Ülseratif kolitin yaygınlığının prognostik önemi iyi bilinmesine karşılık, ilk atağın şiddetinin önemi hakkında çelişkili bilgiler vardır. Bu çalışmanın amacı total kolitisli ülseratif kolit hastalarında ilk atak şiddetinin uzun dönem prognoza etkisini belirlemektir. Yöntem: Ülseratif kolit prognozu 52 total kolitli hastada retrospektif olarak belirlendi. Hastalar ilk atağı şiddetli (grup 1) ve hafif (grup 2) olmak üzere ikiye ayrıldı. Bulgular: Grup1'de 28 (%89.3) hasta ve grup 2'de 24 (%62.5) hasta takip süresinde nüks etti (p<0.05). İkiden fazla relaps olma olasılığı (11/28, %39.3) ve 5/24, %20.8)(p=0.06) ve şiddetli relap olma olasılığı (17/28, %70.8 ve 7/24, %29.1)(p<0.05) ilk atağı şiddetli olan hastalarda daha fazla idi. Her iki grupta aktif hastalık süresi benzerdi (grup 1'de 10.10±11.1 ay ve grup 2'de 8.63±11.0 ay) (p=0.617). Grup 1'de 9 hasta (%32.1) ve grup 2'de 4 hasta (%16.7) cerrahi geçirdi (p=0.26). Grup 1 ve 2'de mortalite farklı değildi (1/28, %3.5 ve 0/24, %0)(p=0.91) Sonuç: İlk atağı şiddetli olan hastalarda nüks eden hasta sayısı, hafif olanlara göre daha fazladır; bu hastaların nüksleri de şiddetli olma eğilimindedir. Fakat, etkili medikal ve cerrahi tedavilerle morbidite ve mortalite oranları daha fazla değildir.
Abstract
Background/aims: The extent of colon affected in ulcerative colitis is a major factor in the long-term prognosis of the disease. The aims of this study were to examine the effect of first attack severity on initial prognostic factors influencing the subsequent long-term course for patients not undergoing colectomy at first attack. Methods: The prognosis of ulcerative colitis was studied retrospectively in 52 patients. Two groups of patients were identified according to first attack severity: patients in whom the first attack was determined as severe (group 1) and a second group in whom the first attack appeared to be mild (group 2). Results: Twenty-five of the 28 (89.3%) patients in group 1, and 15 of the 24 (62.5%) patients in group 2 relapsed during the follow-up period (p<0.05). Patients with a severe first attack tended to have more than two relapses (11/28, 39.3% in group 1 vs 5/24, 20.8% in group 2) (p = 0.06) and have severe relapses (17/28, 70.8% in group 1 vs 7/24, 29.1% in group 2) (p<0.05). The total time of flare-ups was similar in the two patient groups ( 10.10±11.1 months in group 1 vs 8.63±11.0 months in group 2) (p = 0.617). Nine (32.1%) of group 1 and four (16.7%) of group 2 patients underwent surgery (p = 0.19). The mean duration of surgery was also similar (28.11±20.1 vs 35.00±8.4) (p = 0.26). Eight of nine patients in group 1 and all those in group 2 underwent colectomy for failure of medical therapy. Only one patient with a severe first attack underwent surgery for toxic megacolon. The mortality rate in group 1 (1/28, 3.5%) and group 2 (0/24, 0%) patients was also similar (p=0.91). Conclusions: Patients with a severe first attack relapsed more frequently than those who had mild attacks and these relapses tended to be more severe. The introduction of effective medications and improved surgical procedures, however, have diminished the morbidity and mortality rates.