Abstract
Background
In patients with chronic refractory ulcerative colitis (UC) the precise timing for
indication to colectomy is unclear.
Aims
We performed a systematic review of the literature on the risk factors for colectomy
in patients with chronic refractory UC in the biologic era.
Methods
PubMed Central/Medline and Embase were systemically searched for records published
between January 2000 and December 2017. Current evidence was summarized and filtered
by expert opinion.
Results
70 studies were included in the qualitative synthesis. Several factors were found
to be associated with a higher or reduced risk for colectomy, including variables
at baseline – such as progression from proctitis/left-sided to extensive colitis,
extensive colitis at diagnosis, high baseline C Reactive Protein or erythrocyte sedimentation
rate, male gender, and younger age at diagnosis – previous medical history, and factors
arising during therapy with biologics, including the absence of clinical response
after induction with infliximab or adalimumab, and the lack of mucosal healing during
therapy with anti-TNFs.
Conclusions
Two main points may help physicians to decide when the surgical option may be considered
in patients with chronic refractory UC: (1) a first risk stratification can be obtained
by analyzing factors at baseline and medical history, including the previous exposure
to anti-TNFs; (2) during therapy with biologics, the early assessment (after 12–16
weeks of treatment) of clinical and endoscopic response is a strong predictor of the
subsequent risk of colectomy.
Keywords
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Article info
Publication history
Published online: February 06, 2019
Accepted:
January 21,
2019
Received:
October 28,
2018
Identification
Copyright
© 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
