• Which Patients with Early-stage Ulcerative Colitis Have the Worst Prognoses?

Which Patients with Early-stage Ulcerative Colitis Have the Worst Prognoses?

It is a challenge to accurately identify patients with early-stage ulcerative colitis (UC) who are at highest risk for a poor outcome and therefore might require salvage therapy.

In a Perspective article in the April issue of Clinical Gastroenterology and Hepatology, Walter Reinisch et al present prognostic factors for adults with newly diagnosed UC, and discuss which patients might benefit from rapid and progressive therapy.

Patients with poor prognoses tend to be young nonsmokers with high levels of inflammatory biomarkers, low levels of hemoglobin, and extensive disease, based on colonoscopy.

Reinisch et al explain that effective management of these patients requires early recognition of the patient’s condition, and close monitoring during early stages of treatment, so that appropriate steps can be taken if the initial treatment is not effective.

They present two hypothetical cases to illustrate the challenge:

Patients A and B presented with similar symptoms. Laboratory and colonoscopy results indicated a worse prognosis for patient A. Initial treatment should be similar for these patients, but patient A is more likely to need aggressive therapy as the next step.

Patients A and B presented with similar symptoms. Laboratory and colonoscopy results indicated a worse prognosis for patient A. Initial treatment should be similar for these patients, but patient A is more likely to need aggressive therapy as the next step.

 

The patients presented with similar symptoms, yet their predicted outcomes differ due to characteristics such as age, smoking status, and laboratory test and endoscopy results.

Reinisch et al review findings from epidemiologic and clinical studies showing that patients with UC at highest risk for poor outcome tended to be young nonsmokers who were hospitalized soon after diagnosis, patients with high levels and C-reactive protein and erythrocyte sedimentation rates, patients with low levels of hemoglobin, and those who had extensive colitis with deep ulcerations.

The authors also discuss other serologic, genetic, histologic, and endoscopic factors that can predict patient outcomes.

Finally, they describe new markers and tests that could increase our ability to rapidly identify high-risk patients, such as the point-of-care fecal calprotectin test to distinguish patients with inflammatory bowel diseases from those with other disorders.

Further, prospective studies are needed to validate prognostic factors and to evaluate whether early introduction of biologic or immunosuppressive therapy in high-risk patients slows disease progression.

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