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Management of acute severe colitis
Simon L Jakobovits1, S P L Travis
1Gastroenterology Unit, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK. sjakobovits@hotmail.com
British Medical Bulletin
|July 19, 2006
Summary
Prompt treatment for severe ulcerative colitis involves recognizing unwell patients and assessing medical failure risk. Early intervention with corticosteroids or biologics like infliximab can prevent colectomy, though long-term outcomes vary.
Area of Science:
- Gastroenterology
- Internal Medicine
- Clinical Pharmacology
Background:
- Acute severe ulcerative colitis (ASUC) management requires prompt recognition and treatment to avoid surgery.
- Intravenous corticosteroids are first-line but only effective in 40% of patients.
Purpose of the Study:
- To outline the management strategy for acute severe ulcerative colitis.
- To discuss the role of early intervention and objective assessment in treatment decisions.
- To review current and emerging therapeutic options.
Main Methods:
- Review of current clinical practice guidelines and literature on ASUC management.
- Analysis of treatment outcomes for corticosteroids, ciclosporin, and infliximab.
- Discussion of decision-making criteria for escalating therapy or colectomy.
Main Results:
- Corticosteroids are effective in 70% of ASUC patients, with 30% requiring colectomy.
- Early use of ciclosporin or infliximab can be considered for steroid-refractory cases.
- Mortality has significantly decreased to <1% in specialist centers due to improved management.
Conclusions:
- Timely recognition and treatment are crucial for managing ASUC.
- Early consideration of immunosuppressants like ciclosporin and biologics like infliximab is vital for non-responders to steroids.
- While colectomy remains an option, newer therapies offer alternatives, though long-term data is pending.