High Dose Prednisone Treatment in Severe Ulcerative Colitis

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Abstract
Kristensen, M., Koudahl, G., Fischerman, K. & Jarnum, S. High dose prednisone treatment in severe ulcerative colitis. Scand. J. Gastroent. 1974, 9, 177-183. The results of high dose prednisone treatment (80-160 mg per day for 11-17 days) are reported in 31 patients with a severe acute attack of ulcerative colitis; 13 patients went into remission and operation was avoided. Colectomy had to be performed in 17 patients, of whom 9 were subjected to ‘acute’ operation because of increasing haemorrhage, toxic megacolon, suspected perforation, or rapid clinical deterioration. There were 4 deaths. One patient who responded to steroid therapy died of pulmonary embolism before discharge. Three patients died in the postoperative phase, one of them, who suffered numerous postoperative complications, not until one year alter proctocolectomy. Among the patients who escaped colectomy, there were 5 who did not respond to prednisone therapy until the dose had been increased (from 80 mg to 160 mg per day) and the period of treatment prolonged During the follow-up study with an observation period of ½ to 7 years (mean; 3 years), 3 patients who primarily improved on prednisone treatment were operated on. It is concluded that intensive medical therapy including a high dose prednisone treatment in severe acute attacks of ulcerative colitis is justified, since it was found to save the colon in 45 % of the cases in the present case material. However, meticulous surveillance, experience, and close collaboration between internist and surgeon are prerequisites before this type of treatment is undertaken.