Abstract
Aim: To compare Ho score with Travis score in predicting steroid responsiveness in acute severe ulcerative colitis.
Methods and Material: Our study is a prospective observational study including all patients who got admitted in Institute of medical gastroenterology, Rajiv Gandhi Government General Hospital, Chennai, between January 2019 and December 2019 with acute severe ulcerative colitis as per True love witts score.
Results: Among 64, 55 were male and 9 were female. Mean age of patients is 32 years (range 16-45 years). Day 3 Travis score was high in 16 patients (25%) and low in 48 patients (75%). 48 patients (75%) were steroid responsive and 16 patients (25%) were steroid non-responsive who received second line therapy in the form of anti-TNF agents. All 4 patients with high Ho score on day 3 were steroid non-responders, 6 patients with intermediate Ho score were steroid responsive and 12 patients with intermediate Ho score on day 3 were steroid non-responders. Ho score of > 2.5 has sensitivity of 62.5% and specificity of 100% in predicting steroid responsiveness.
Conclusion: We conclude that in acute severe ulcerative colitis, patients with high Travis or the Ho scores are more likely to be resistant to IV steroids. In anti-TNF era, the risk of surgery in those high risk patients is lower than previously reported.
Keywords: Acute severe ulcerative colitis, Travis score, Ho score, steroid refractory ulcerative colitis
References
- Dulai, P. S., Levesque, B. G., Feagan, B. G., D’Haens, G., & Sandborn, W. J. (2015). Assessment of mucosal healing in inflammatory bowel disease. Gastrointestinal endoscopy, 82(2), 246-255.
- Rice-Oxley, J. M., & Truelove, S. (1950). Ulcerative colitis course and prognosis. The Lancet, 255(6606), 663-666.
- Edwards, F. C., & Truelove, S. C. (1963). The course and prognosis of ulcerative colitis: Part I Short-term prognosis. Gut, 4(4), 299-308.
- Solberg, I. C., Lygren, I., Jahnsen, J., Aadland, E., Høie, O., Cvancarova, M., ... & IBSEN Study Group. (2009). Clinical course during the first 10 years of ulcerative colitis: results from a population-based inception cohort (IBSEN Study). Scandinavian journal of gastroenterology, 44(4), 431-440.
- Bernardo, S., Fernandes, S. R., Gonçalves, A. R., Valente, A., Baldaia, C., Santos, P. M., & Correia, L. A. (2019). Predicting the course of disease in hospitalized patients with acute severe ulcerative colitis. Inflammatory bowel diseases, 25(3), 541-546.
- Turner, D., Walsh, C. M., Steinhart, A. H., & Griffiths, A. M. (2007). Response to corticosteroids in severe ulcerative colitis: a systematic review of the literature and a meta-regression. Clinical Gastroenterology and Hepatology, 5(1), 103-110.
- Harbord, M., Eliakim, R., Bettenworth, D., Karmiris, K., Katsanos, K., Kopylov, U., ... & Carbonnel, F. (2017). Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 2: Current Management (vol 11, pg 769, 2017). Journal of Crohns & Colitis, 11(12), 1512-1512.
- Truelove, S. C. (1955). Witts LJ. Cortisone in ulcerative colitis. Final report on a therapeutic trial. Br Med J, 2, 1041-1048.
- Travis, S. P., Farrant, J. M., Ricketts, C., Nolan, D. J., Mortensen, N. M., Kettlewell, M. G., & Jewell, D. P. (1996). Predicting outcome in severe ulcerative colitis. Gut, 38(6), 905-910.
- Ho, G. T., Mowat, C., Goddard, C. J. R., Fennell, J. M., Shah, N. B., Prescott, R. J., & Satsangi, J. (2004). Predicting the outcome of severe ulcerative colitis: development of a novel risk score to aid early selection of patients for second‐line medical therapy or surgery. Alimentary pharmacology & therapeutics, 19(10), 1079-1087.
- Lynch, R. W., Churchhouse, A. M. D., Protheroe, A., Arnott, I. D. R., & UK IBD Audit Steering Group. (2016). Predicting outcome in acute severe ulcerative colitis: comparison of the Travis and Ho scores using UK IBD audit data. Alimentary pharmacology & therapeutics, 43(11), 1132-1141.
- Järnerot, G., Rolny, P., & Sandberg-Gertzen, H. (1985). Intensive intravenous treatment of ulcerative colitis. Gastroenterology, 89(5), 1005-1013.
- Seah, D., & De Cruz, P. (2016). the practical management of acute severe ulcerative colitis. Alimentary pharmacology & therapeutics, 43(4), 482-513.
- Travis, S., Satsangi, J., & Lémann, M. (2011). Predicting the need for colectomy in severe ulcerative colitis: a critical appraisal of clinical parameters and currently available biomarkers.
Corresponding Author
L Sujatha
Resident, Madras Medical College, The Tamilnadu Dr MGR University, Chennai