P782 Natural history of acute severe ulcerative colitis in elderly: A population-based study. (16th January 2018)

• Record Type: Journal Article
• Authors: Bril, L; Leroyer, A; Fumery, M; Charpentier, C; Pariente, B; Sarter, H; Laharie, D; Gower-rousseau, C; Savoye, G
• Is Part Of: Journal of Crohn's and colitis. Volume 12:Number 1(2018:Jan.)Supplement 1
• Page Start: S506
• Page End: S506
• Publication Date: 2018-01-16
• Subjects: Inflammatory bowel diseases -- Periodicals; 616.344005
• DOI: 10.1093/ecco-jcc/jjx180.909
• Languages: English
• ISSNs: 1873-9946

Abstract

Abstract: Background: Acute severe attack of ulcerative colitis (ASUC) can occur in 12 to 25% of UC patients. This is a challenging and life-threatening in elderly patients. Evolution of ASUC in late onset UC diagnosed after the age of 60 years is unknown. The aim of this study was to describe clinical presentation, treatment and prognosis of ASUC in a cohort of late onset UC. Methods: In a Northern France population-based cohort, we identified 472 patients aged >60 years at UC diagnosis ulcerative colitis (UC). These patients were followed for a median time of 6.2 years. Among these patients, those hospitalised with an ASUC according to the Truelove's criteria were analysed. Clinical presentation, comorbidities (Charlson index), treatment and surgery needs as well as postoperative complication and mortality were recorded. Results: In total, 23 patients (5%) including 14 men were included. ASUC occurred at diagnosis in 12 patients (52%) and during the first year of follow-up in 19 patients (83%). The Charlson comorbidities score was ≥3 in 96% (n = 22) and ≥5 in 52% (n = 12) of the cases. First-line treatment was intravenous corticosteroid (64%, n = 14), colectomy (22%, n = 4) or exclusive artificial nutrition (24%, n = 5). No patient received second line medical treatment ciclosporin or infliximab. Among the 18 operated patients, median time between admission for severe acute colitis and intervention was 15 days (Q1 = 7, Q3 = 39). Surgery was a subtotal colectomy with double stomy in 13 cases, a partial colectomy in 3 cases, total colectomy in 1 case and a stomy alone in 1 case. Stoma were definitive in 69% ( n = 9) of cases. One or more postoperative complications occurred in six patients (26%), i.e. renal insufficiency ( n = 4), thromboembolic event ( n = 4), septic shock ( n = 2). Five patients (22%) died, of which 4 after surgery, leading to a 3-month survival rate of 75% (IC95% [58–97]) (Figure 1). Conclusions: In this population-based study conducted in the prebiotherapy era ASUC in elderly onset UC patient was rare but particularly severe requiring surgery in 74% of patients and life-threatening with a mortality rate close to 25% at 3 months. Management of these severe patients in referral centres is mandatory.