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Background and aim We aimed to evaluate the outcome of patients with acute severe ulcerative colitis previously exposed to immunosuppressive (IMS) therapy. Methods We retrospectively collected data from 86 consecutive patients from 2008. Early outcome was evaluated as response to steroids, rescue therapy, and colectomy rate, whereas colectomy free-survival was determined along the follow-up. Results The overall response rates to steroids and rescue therapy was 33.7% and 90.5%, respectively, while early colectomy rate was 22.1%. Patients previously treated with IMS (n = 47) showed a trend towards lower response to steroids (25.5% vs 43.6%; p = 0.10), and a high-risk of early colectomy (29.8% vs 12.8%; p = 0.07), but a similar response to rescue therapy (87.5% vs 94.4%, p = 0.62) when compared with IMS-naive patients (n = 39). The overall cumulative probability to avoid the surgery was 67.5% and 56.6% at 12 and 60 months, respectively, regardless of previous exposure to IMS (p = 0.30). At multivariate analysis the risk of early colectomy was increased by previous IMS (OR 5.16, p = 0.017), anaemia (OR 4.26, p = 0.02), and diagnosis above 40 years (OR 5.31, p = 0.011). Conclusions Patients previously treated with IMS showed a non-significant trend towards a worse response with steroid therapy, a satisfactory response rate to rescue therapy, and a similar probability of avoiding colectomy during the follow-up vs IMS-naive patients.

Background There is no consensus on the leading causes of death among inflammatory bowel diseases (IBD) patients. Aim We present the results of an extended follow-up of the population-based Florence IBD cohort, including 689 ulcerative colitis and 231 Crohn's disease patients. Methods The causes of death of cohort members were determined through linkage with the local mortality registry. We calculated standardized mortality ratios (SMR) and 95% confidence intervals (95%CI) by applying gender-, age- and calendar time–death rates to person-years at risk. Results Ulcerative colitis patients had overall mortality comparable to the general population (SMR 0.99, 95%CI 0.85–1.14), though being at increased risk of dying from Hodgkin's disease (SMR 11.74, 95%CI 2.94–46.94), rectal cancer (SMR 3.69, 95%CI 1.66–8.22) and Alzheimer's disease (2.40, 95%CI 1.00–5.76). Crohn's disease patients had an increased overall mortality (SMR 1.79, 95%CI 1.39–2.27) and were at higher risk of dying from cancer (SMR 2.57, 95%CI 1.28–5.13) and non-cancer diseases of the respiratory system (SMR 2.51, 95%CI 1.05–6.04), brain cancer (SMR 6.26, 95%CI 1.57–25.02) and non-cancer diseases of the genitourinary system (SMR 4.38, 95%CI 1.10–17.52). Conclusions IBD patients should be offered counselling on risk reduction strategies, as much of their mortality excess is potentially avoidable.