Ulcerative colitis: deep ulceration increased the risk of dilatation.

Clinical bottom line (level 4)

  1. Patients with acute colitis who had deep ulceration were more likely to develop dilatation of the colon (NNH = 2 at unknown) . The effect on perforations was unclear.
Buckell et al: Gastroenterology 1980; 79 (1): 19-25
Expires May 2003

The study

Retrospective cohort study with objective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: 15 acute hospitals, UK

40 patients (aged ?, ?% male) acute colitis (80% ulcerative colitis, remainder idiopathic) treated with urgent colectomy

Excluded if
  • evidence of Crohn's disease, infection or ischaemia on histology



    • Factors studied:
  • severe ulceration
  • severe ulceration




    • 100% followed for until surgery
    Outcomes studied:
  • dilatation diagnosed on plain abdominal film
  • perforation

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    dilatation until surgery 22/31 71%
    (55% to 87%)
    perforation until surgery 4/31 13%
    (1.1% to 25%)

    prognostic factor for
    dilatation     		time to outcome unadjusted RR
    (95% CI)    		 NNF+
    (95% CI)
    severe ulceration until surgery 2.48
    (1.12 to 5.48)     		2
    (1 to 23)

    prognostic factor for
    perforation     		time to outcome unadjusted RR
    (95% CI)    		 NNF+
    (95% CI)
    severe ulceration until surgery inf
    (0.67 to inf)
    ( to )

    Comments

    1. Failure to adjust for confounding factors such as disease severity make these results less certain.

    Citation

    1. Buckell NA, Williams GT, Bartram CI, et al: Depth of ulceration in acute colitis: correlation with outcome and clinical and radiologic features. Gastroenterology 1980; 79 (1): 19-25
    Search Terms: colit* in Cochrane
    Contributor: Chris Ball and Clare Wotton, September 2000
    Reviewer:

    Clinical Question.
    Patient acute colitis
    Intervention or Exposure risk factors
    Outcome deep ulceration