STEROID COMPLICATIONS AND SURGERY IN INTRACTABLE ULCERATIVE-COLITIS

The major operative indication for ulcerative colitis is intractabilit y. Although steroid side effects appeal-to be closely associated with surgical indications for intractable ulcerative colitis. this relation ship has yet to be analyzed in detail. To elucidate this relationship, we investigated 39 surgical patients with intractable ulcerative coli tis. as defined by the Research Committee for Intractable Diseases of the Ministry of Health and welfare of Japan, and 66 conservatively tre ated patients with ulcerative colitis, of whom 6 had intractable disea se. All patients with major steroid side effects and 17/24 (71%) patie nts with minor side effects underwent: surgery. The median number of a dmissions was higher in patients with major side effects than in those with less severe or no side effects in the operative series, while th is value was lower in the non-operative series than in the operative s eries. This tendency was similar for the total duration of hospitaliza tion and the number of relapses. In the operative series, markedly hig her steroid doses were administered to patients with side effects than to those without, and lower doses were given in the non-operative ser ies, On multivariate regression analysis, the presence of steroid side effects, disease extent, and disease duration were significantly asso ciated with surgery. Patients without side effects had a higher postop erative complication rate than those with minor side effects. We concl ude that major side effects are a surgical indication for patients wit h intractable ulcerative colitis, and that even minor side effects sho uld be taken as a surgical indication in view of the patient's quality of life.