Marijana Nedeljkovic Protic

BACKGROUND: The prognosis of acute severe ulcerative colitis (ASC) influences therapeutic decisions, but data on prevalence or long-term outcome are few. METHODS: A systematic review of all patients with UC diagnosed in Oxford was performed to assess the prevalence of ASC defined by Truelove and Witts' (TW) criteria and determine whether outcome is related to disease activity on admission, likelihood of recurrence and long-term prognosis. RESULTS: 750 patients (median follow up 12.7 yr, range 0-648 mo) met inclusion criteria out of a total cohort of 1853 patients. 24.8% (186/750) had at least one admission for ASC (294 admissions in 186 patients). Overall, 12% (93/750) had a colectomy, compared to 39.8% (74/186) of patients with one or more episodes of ASC (p<0.0001) and 3.4% (19/564) in those with no admission. The colectomy rate on first admission (37/186, 19.9%) was lower than on the second or subsequent admissions (OR 2.35, 95% CI 1.33-4.14, p=0.003), being 29.0%, 36.6%, 38.2% after two, three, or subsequent episodes respectively. It was 8.5% (11/129) if patients had one TW criterion in addition to ≥6 bloody bowel motions/day, compared to 31% (29/94) if two additional criteria were present and 48% (34/71) if three or more additional criteria were present (p=1.4 × 10⁻⁵; OR 4.35, 95% CI 2.20-8.56 one criterion vs two or more). CONCLUSIONS: A quarter of all patients with ulcerative colitis experience at least one episode of ASC; 20% come to colectomy on first admission, but 40% after two admissions. The likelihood of colectomy is related to biological severity on admission.

Introduction: For 30 years, 5-aminosalicylic acid (5-ASA) has been the backbone of therapeutic management in patients with ulcerative colitis (UC). In the biologic era, it still remains the treatment of choice in mild-to-moderate UC. Positioning of this therapeutic class in moderate-to-severe UC is less clear.Areas covered: Several studies demonstrated the ability of 5-ASA to induce endoscopic remission to a similar extent as anti-TNF therapy on the moderate segment of UC. Histologic remission is achieved after induction in up to 45% of patients treated with topical 5-ASA and 30% with oral formulations. Aminosalicylates offer a favorable safety profile compared to that of immunomodulators and biologics. High-dose 5-ASA therapy may be a valuable option for patients with moderately active disease, and physicians should weigh the pros and cons of this strategy in selected patients. Whether aminosalicylates should be continued in combination with thiopurines or biologic therapy remains under debate.Expert opinion: In the era of biologics, aminosalicylates remain the first-line therapy in patients with mild UC, and have to be considered in case of moderate UC, given their favorable risk-benefit profile. We suggest that 5-ASA should be used in moderate patients without poor prognostic factors, while biologics should be preferred otherwise.

Real-world data are used to inform decision-makers and optimise therapeutic management for patients with ulcerative colitis (UC) and Crohn’s disease (CD). We analysed data on the epidemiology (by using proxies of prevalence and incidence), patient characteristics, treatment patterns and associated healthcare direct costs for the management of patients with UC and patients with CD in Italy. This retrospective observational study used administrative databases from eight Local Health Units geographically distributed across Italy. Adult patients with a hospitalisation and/or an exemption for UC or CD were included. Study outcomes were summarised descriptively, and limited statistical tests were performed. At baseline, 9255 adults with UC and 4747 adults with CD were included. Mean (standard deviation) age at inclusion was 54.0 (18.4)/48.6 (18.1) years, for UC/CD. The estimated average incidence of UC and CD for the period 2013–2020 was 36.5 and 18.7 per 100,000, respectively. The most frequently prescribed drug category for patients with UC/CD was conventional treatment [mesalazine and topical corticosteroids (67.4%/61.1%), immunomodulators and systemic corticosteroids (43.2%/47.7%)], followed by biologic treatments (2.1%/5.1%). The mean annual total direct cost per patient was 7678 euro (€), for UC and €6925 for CD. This analysis, carried-out in an Italian clinical setting, may help to optimise therapy for patients with UC and CD and provide relevant clinical practice data to inform decision-makers. Data from clinical practice can be used to guide healthcare decisions and optimise treatment for patients with ulcerative colitis and Crohn’s disease. This study used anonymised patient information from almost four million individuals across Italy to describe the epidemiology, patient characteristics, treatment patterns and healthcare costs of patients with ulcerative colitis and Crohn’s disease. Adults with an Italian National Health System code in their records associated with the diagnosis of ulcerative colitis or Crohn’s disease were included. Baseline characteristics were balanced between groups and rates of perceived incidence were numerically similar to the results reported in similar Italian studies. This study found that patients with ulcerative colitis and Crohn’s disease were most often prescribed conventional treatments, and biological treatments were least-commonly prescribed. More than half of patients with ulcerative colitis and nearly half of those with Crohn’s disease were persistent with first (index) treatment of mesalazine and topical corticosteroids and with biologic index treatment during the follow-up period. Switch occurred in up to approximately a quarter of patients with ulcerative colitis and Crohn’s disease. The main factors that predicted switch were index biologic for ulcerative colitis and baseline comorbidities for Crohn’s disease. The average direct cost per patient in 1 year was 7678 euro (€) for ulcerative colitis and €6925 for Crohn’s disease. The results of this analysis may help to optimise therapy for patients with ulcerative colitis and Crohn’s disease, and to inform decision-makers in healthcare systems on which treatment options provide value for money and benefit patients.

The initial outcome, likelihood of recurrence and long-term prognosis of acute severe ulcerative colitis (ASUC) are measures of the burden of disease and therefore influence therapeutic decisions. There are few data on the prevalence and characteristics of ASUC, although the UK National IBD Audit (2006) estimates that 1 patient is admitted to every UK hospital each month. Methods and Aims: The aims of this study were to define these characteristics and determine if the outcome was related to the number of Truelove and Witts' criteria (TWC) on admission. A systematic, retrospective study of all patients with UC diagnosed in Oxford from 1950-2007 was performed. Non-Oxford diagnosed patients were excluded from the analysis. ASUC as defined by TWC was the indication for admission for intensive therapy throughout this period. Demographic, clinical and biomedical characteristics on admission were recorded, with medical or surgical treatment and outcome. Results: 747 patients with UC diagnosed in Oxford between 1950-2007 (median follow up 129.0 months, range 0-647.6 months) were evaluated out of a total cohort of 1827 patients. Of these, 27.6% (206/747) had ASUC as defined by TWC. There were 317 admissions in 206 patients. Age at latest follow up in those with an episode of ASUC was significantly lower than those without an episode (49.6 vs 53.1 yr, p=0.007), but there was no significant difference in gender or duration of disease. 49.3% were admitted within 1 year of initial diagnosis (median time to admission 12.7 months, range 0-453.4 months). 67% had a single episode, 20% had two, and 13% three or more episodes. 87/227 (38.7%) of patients with one or more episodes of ASUC had a colectomy. The likelihood of colectomy on the first, second, third, fourth and fifth admissions was 19.9%, 29.0%, 36.6%, 38.2%, 39.8% respectively. Although half of all colectomies (36/75) occurred on the first admission the colectomy rate on the first admission (48/152, 31.5%) was lower than on the second or subsequent admissions (39/75, 52.0%; OR 2.35, 95% CI 1.33-4.14, p=0.003). 18/147 patients who had a single TWC in addition to a bloody stool frequency 6/day required colectomy, whilst 61/170 patients who had 2 additional TWC required colectomy (p=1.2x10 - ; OR 4.01, 95% C.I. 2.24-7.19) (+1 additional criterion = 18/147 (12.2%); +2 = 30/99 (31.3%); +3 =27/59 (45.8%); +4 = 4/12 (33.3%). Conclusions: This is the largest single centre cohort study on the natural history of ASUC. A quarter of all UC patients experience at least one episode of ASUC. A third come to colectomy on the first admission, but half of those who have two or more admissions come to colectomy. When there are two or more TWC in addition to a bloody stool frequency 6/day, the risk of colectomy is four fold-higher than when there is only one additional TW criterion on admission.

This paper is a brief review of the use of aluminum honeycomb as a modified aerospace material in the conservation and presentation of mosaics.