SPECTRUM OF ULCERATIVE-COLITIS IN NORTH-INDIA

We analyzed retrospectively the characteristics of 87 patients with ul cerative colitis seen in a tertiary care center in north India. Ulcera tive colitis was diagnosed on the basis of clinical features, sigmoido scopy, rectal biopsy, and exclusion of microbiological causes of colit is. Severe clinical disease was seen in 53 (60%) patients that correla ted with extensive colonic involvement (p < 0.001), severe changes on sigmoidoscopy (p < 0.001) and histology (p < 0.001), erythrocyte sedim entation rate (ESR) of > 30 mm for the first hour, and serum albumin o f < 3 g/dl (p < 0.001). Remission of the disease was maintained on sul fasalazine in 18 (20.7%) patients, whereas 47 (54%) required steroids. Proctocolectomy with ileoanal anastomosis was done in 22 (25.3%) pati ents in whom there was poor response to medical treatment. Postoperati ve complications were seen in seven (31.8%) patients, and death occurr ed in four (18.1%) patients. Ulcerative colitis thus commonly presents as severe disease, with the majority of patients requiring surgery du e to poor response to medical therapy. This pattern of disease as seen in an academic referral hospital in north India is virtually indistin guishable from that seen in similar centers in the West. However, in o ur setting, proctocolectomy and ileoanal anastomosis is cost-effective in patients unresponsive to, or unable to afford, drug treatment.