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History of medical hospitalization predicts future need for colectomy in patients with ulcerative colitis

Ananthakrishnan, Ashwin N. MD, MPH1; Issa, Mazen MD1; Beaulieu, Dawn B. MD1; Skaros, Sue PA‐C1; Knox, Josh F. PA‐C1; Lemke, Kathryn PA‐C1; Emmons, Jeanne RN1; Lundeen, Sarah H. APNP2; Otterson, Mary F. MD, MS2; Binion, David G. MD1*

Inflammatory Bowel Diseases:
doi: 10.1002/ibd.20639
Original Article
Abstract

Background:: Patients who require hospitalization for the management of ulcerative colitis (UC) may represent a subset with severe disease. These patients may be more likely to require future colectomy. There are limited data examining whether medical hospitalization is predictive of subsequent colectomy.

Methods:: This was a retrospective case–control study utilizing the inflammatory bowel disease center database at our academic referral center. Cases comprised UC patients who underwent colectomy for disease refractory to medical management. The control population was comprised of all patients with UC who had not undergone colectomy. Multivariate logistic regression was used to identify independent predictors of requiring colectomy.

Results:: There were a total of 246 UC patients included in our study, with 103 being hospitalized sometime in their disease course (41.9%). A total of 27 patients underwent colectomy (11%). Colectomy patients were significantly more likely to have been on infliximab therapy (51.8% versus 22.4%, P = 0.001) but no more likely to have been on immunomodulator therapy (74.1% versus 59.4%, P = 0.14). Patients who required medical hospitalization for UC were more likely to require future colectomy (20.4% versus 4.2%, P < 0.001) than those who had not required hospitalization. On multivariate analysis, requiring medical hospitalization for management of UC (odds ratio [OR] 5.37, 95% confidence interval [CI] 2.00–14.46) and ever requiring infliximab therapy (OR 3.12, 95% CI 1.21–8.07) were independent predictors of colectomy.

Conclusions:: Requiring medical hospitalization for the management of disease activity in UC is an independent predictor of the need for colectomy. Future studies will determine whether aggressive medical management may modify the need for colectomy in this cohort.

Author Information

1 Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin

2 Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin

* Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, 857 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261

Email: binion@pitt.edu

Received 18 June 2008; Accepted 1 July 2008

Published online 4 August 2008 in Wiley InterScience (www.interscience.wiley.com).

Presented in part as a poster at the Digestive Disease Week, San Diego, CA, May 17–22, 2008.

© Crohn's & Colitis Foundation of America, Inc.

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