Left-sided colitis and extensive colitis have similar colectomy rates after index episode of acute severe colitis: A long-term follow-up study

Background and Aim The extent of disease of ulcerative colitis (UC) has been found to be a predictor of acute severe colitis (ASC), but it is unclear whether the extent of disease at the index episode of ASC is a predictor of long-term outcome. Methods Hospitalized patients satisfying Truelove and Witts' criteria under follow-up at a single center from January 2003 to December 2016 were included. The extent of disease at index ASC was classified according to the Montreal classification as left-sided or extensive colitis. Extent was used to predict the long-term risk of colectomy or steroid dependence following an index episode of ASC. Results Of 2076 patients with ulcerative colitis, 241 (12%) had an index episode of ASC. In total, 34 (14%) patients underwent a colectomy at index admission and 53 (26%) over a median follow-up of 48(1-172) months. Left-sided colitis and extensive colitis did not differ in the rate of colectomy at index admission (12% vs 15%, P = 0.4) and colectomy in follow-up (31% vs 23%, P = 0.17). Readmission due to ASC was also similar between the two groups (28% vs 32%, P = 0.6). Conclusion Extent of disease at index ASC does not predict colectomy at admission and over the long term.