Early Sigmoidoscopy Improves Acute Severe Ulcerative Colitis Outcome

A recent study published in Journal of Crohn's and Colitis has shed light on the benefits of early sigmoidoscopy in patients hospitalized with acute severe ulcerative colitis (ASUC). Spanning from January 2012 to November 2021, the study by Shreyak Sharma and team aimed to assess whether the timing of sigmoidoscopy affected relevant clinical outcomes in this specific patient cohort.

The research, involving 112 ASUC patients who underwent sigmoidoscopy, revealed that performing the procedure within 72 hours of admission significantly improved clinical outcomes compared to delayed sigmoidoscopy, defined as occurring more than 72 hours after admission.

Key findings from the study indicated that patients who received early sigmoidoscopy experienced numerous advantages over their delayed-sigmoidoscopy counterparts. Notably, the early group had a substantial reduction in the cumulative days of intravenous corticosteroid (CS) use, with an average of 4.5 days compared to 9.2 days in the delayed group (P < .001). Additionally, the early sigmoidoscopy patients had significantly shorter hospital stays, averaging 6.4 days, in contrast to 19.3 days for the delayed group (P < .001).

Moreover, time to infliximab (IFX) rescue, a crucial measure of treatment efficacy, was markedly improved in patients who received early sigmoidoscopy (3.5 days) compared to those with delayed sigmoidoscopy (6.4 days) (P = .004).

While colectomy rates were slightly higher in the delayed sigmoidoscopy group (28%) than the early sigmoidoscopy group (17%), the difference was not statistically significant (P = .23). However, the study identified a concerning trend – longer time to sigmoidoscopy was associated with a 16% increased risk of colectomy, underlining the importance of timely intervention in ASUC patients (HR = 1.16, P = .002).

The results of this well-characterized cohort provide valuable insights into the benefits of early sigmoidoscopy in managing ASUC, particularly in terms of reducing CS usage, hospital stays, and the need for colectomy. Such findings are vital in guiding clinical practices and optimizing patient outcomes in the management of ASUC. 

Reference:

Sharma, S., Li, D. K., Levine, L. J., Chaar, A., McMillan, C., Gaidos, J. K. J., Proctor, D. D., & Al-Bawardy, B. (2023). Early Flexible Sigmoidoscopy Improves Clinical Outcomes in Acute Severe Ulcerative Colitis. In Crohn’s & Colitis 360 (Vol. 5, Issue 3). Oxford University Press (OUP). https://doi.org/10.1093/crocol/otad032