Risk factors and timing for colectomy in chronically active refractory ulcerative colitis: A systematic review.

摘要: Abstract Background In patients with chronic refractory ulcerative colitis (UC) the precise timing for indication to colectomy is unclear. Aims We performed a systematic review of literature on risk factors in UC biologic era. Methods PubMed Central/Medline and Embase were systemically searched records published between January 2000 December 2017. Current evidence was summarized filtered by expert opinion. Results 70 studies included qualitative synthesis. Several found be associated higher or reduced colectomy, including variables at baseline – such as progression from proctitis/left-sided extensive colitis, diagnosis, high C Reactive Protein erythrocyte sedimentation rate, male gender, younger age diagnosis previous medical history, arising during therapy biologics, absence clinical response after induction infliximab adalimumab, lack mucosal healing anti-TNFs. Conclusions Two main points may help physicians decide when surgical option considered UC: (1) first stratification can obtained analyzing exposure anti-TNFs; (2) early assessment (after 12–16 weeks treatment) endoscopic strong predictor subsequent colectomy.