P163 Abdominal X-ray: an invaluable tool in Acute Severe Ulcerative Colitis

Correia, J.(1);Gomes, C.(1);Afecto, E.(1);Estevinho, M.(1);Rodrigues, A.(1);Silva, A.P.(1);Fernandes, C.(1);Ponte, A.(1);Silva, J.C.(1);Freitas, T.(1);

(1)Centro Hospitalar de Vila Nova de Gaia/Espinho EPE, Gastroenterology and Hepatology Department, Vila Nova de Gaia, Portugal;


Intravenous steroids (IV-S) remain the cornerstone of treatment of Acute Severe Ulcerative Colitis (ASUC). However, one-third of these patients are refractory to this treatment. Several indices have been developed to predict the failure of IV-S for ASUC, using clinical data at day 3 of treatment. However, indices able to predict IV-S failure based on admission data are lacking.


A retrospective analysis of all consecutive hospital admissions due to ASUC, in a Portuguese tertiary centre, between February 2007 and April 2021 was performed. Only patients receiving IV-S for at least 3 consecutive days were included in this study. IV-S non-response was defined as the need for a second-line therapy or surgery. The following clinical data was collected from each patient: age, gender, disease duration, Montreal disease extension, previous ASUC, previous and on admission medical therapies (oral mesalazine, rectal mesalazine, oral steroids, immunosuppressants and monoclonal antibodies), fever on admission and weeks of symptoms’ worsening before admission. The following parameters on admission were also registered: C-reactive protein, albumin level, hemoglobin, leucocytes count, platelets count, Mayo endoscopic subscore and presence of transverse colonic dilatation on abdominal X-ray ≥5.5 cm. Univariate analysis was used to identify predictive factors of IV-S failure.


68 patients (64.7% female), with a mean age of 40.4 (±16.2) years, were included in this study. 9 patients (13.2%) did not respond to IV-S therapy. On univariate analysis, only transverse colonic distension on X-ray was more frequent in IV-S non-responders (33.3% vs 6.8%, p=0.04).


Clinical data on admission, including previous medication, analytical parameters and endoscopic activity were not predictive of IV-S refractoriness in this population. However, abdominal X-ray showed to be useful to predict the need for a rescue therapy. These findings highlight, in one hand, the need of larger studies to identify on admission predictors of IV-S refractoriness and, in other hand, the importance of abdominal X-ray, in patients admitted due to ASUC.