Possible role of early transabdominal ultrasound in patients undergoing cytapheresis for active ulcerative colitis

Intern Med. 2011;50(1):11-5. doi: 10.2169/internalmedicine.50.4135. Epub 2011 Jan 1.

Abstract

Background: Cytaphresis (CAP) is an effective modality in the treatment of active ulcerative colitis (UC), but the time lag before a notable clinical response on scheduled therapy frequently causes a significant delay in the modification of treatment. We previously reported that the clinical response after CAP was predicted by early application of transabdominal ultrasound (TAUS), but the predictability of long-term outcome after CAP still remains uncertain. METHODS PATIENTS: Twenty-six patients with active UC who received CAP were followed for 1 year. In addition to CAP they received pharmaceutical regimens, such as corticosteroid, 5-aminosalicylic acid, and immunomodulator, as indicated clinically. The mean UC-DAI score was 9.7 before CAP, and 3.2 at 1 year after CAP. Prognostic factor: Total colonic wall thickness was measured by TAUS at 2 to 3 weeks after the initiation of the treatment, and decrement from baseline was calculated. Early ultrasonographic response (EUR) was defined as a decrement statistically. UC-DAI score of 2 or less at 1 year was defined as sustained clinical remission. Score of 6 or more was defined as clinical relapse.

Results: EUR was defined as a decrement in wall thickness by at least 2.5 mm from the baseline. EUR was noted in 11 patients, and the remaining 15 did not attain EUR.

Outcome measures: In the UC-DAI score measured at 1 year after initiation of treatment 90.9% of patients with EUR, whereas 40.0% with non-EUR (p<0.05) showed sustained clinical remission. Regarding relapse, within 1 year 9.1% of patients with EUR relapsed whereas 46.7% with non-EUR (p<0.05) relapsed.

Conclusion: Early application of TAUS may predict the long-term clinical outcome after CAP in patients with active UC.

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Aged
  • Colitis, Ulcerative / diagnostic imaging*
  • Colitis, Ulcerative / drug therapy
  • Colitis, Ulcerative / therapy*
  • Colon / diagnostic imaging
  • Cytapheresis*
  • Female
  • Humans
  • Immunologic Factors / therapeutic use
  • Male
  • Mesalamine / therapeutic use
  • Middle Aged
  • Predictive Value of Tests
  • Prognosis
  • Recurrence
  • Time Factors
  • Treatment Outcome
  • Ultrasonography
  • Young Adult

Substances

  • Adrenal Cortex Hormones
  • Immunologic Factors
  • Mesalamine