Clinical and endoscopic parameters at presentation that predict the need for long-term immunosuppression in ulcerative colitis

Abstract

Abstract Introduction: The clinical course of ulcerative colitis (UC) ranges from a mild course with prolonged periods of remission to severe disease requiring long-term immunosuppression for disease control. There is limited data on the predictors of need for immunosuppression at presentation. Objective: The aim was to evaluate clinical, endoscopic and histopathological parameters at presentation in patients with UC that predict the need for long-term immunosuppressive therapy. Materials and Methods: We studied 81 patients (males; 40; mean age 38.69 ± 12.90 years) with UC (41 prospectively and 40 retrospectively). The clinical presentation, duration, extra-intestinal features, extent of disease, haematological and biochemical features, histology and outcome (drugs, surgery, and mortality) were recorded and analyzed. Subgroup analysis was done after dividing the patients into two groups depending upon whether they needed long term immunosuppressants or not. Results: The presenting symptoms were bloody stools (100%), mucus in stools (98.8%), abdominal pain (35.8%), anorectal pain (14.8%) and extra-intestinal symptoms (4.9%). Of these 81 patients, 7 (8.6%) patients required surgery and 2 (2.4%) patients died. Long term immunosuppressants were used in 19 patients (Azathioprine 16, Mycophenolate mofetil 2 and Tacrolimus 1). The patients who received immunosuppressants had a higher prevalence of pancolitis (47.4% vs. 16.1%, P = 0.005). Other clinical, hematological and histological parameters such as inflammatory grade, chronicity grade, cellular infiltrates, submucosal fibrosis, Paneth cell metaplasia, and the presence of neuronal cells were similar in the two groups. Conclusion: Of the clinical, biochemical, endoscopic and histological features at presentation only the presence of pancolitis predicts the need for long term immunosuppressants in ulcerative colitis.