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Management of acute severe ulcerative colitis
Glen A Doherty1, Adam S Cheifetz
1Center for Inflammatory Bowel Disease, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA. gdoherty@bidmc.harvard.edu
Expert Review of Gastroenterology & Hepatology
|August 14, 2009
Summary
Ulcerative colitis management often involves oral medications, but severe cases may require hospitalization. For steroid-refractory colitis, rescue therapy with ciclosporin or infliximab, or surgery, are key treatment options.
Area of Science:
- Gastroenterology and Internal Medicine
- Inflammatory Bowel Disease Research
Background:
- Ulcerative colitis (UC) is a chronic inflammatory condition with relapsing-remitting episodes.
- Most UC patients are managed with oral medications, but 15% experience severe exacerbations requiring hospitalization.
Purpose of the Study:
- To review treatment strategies for acute severe ulcerative colitis (ASUC) unresponsive to corticosteroids.
- To discuss the roles of rescue medical therapy and surgery in steroid-refractory colitis.
Main Methods:
- Literature review of treatment options for ASUC.
- Analysis of outcomes for medical rescue therapies (cyclosporin, infliximab) and surgical interventions.
Main Results:
- Intravenous corticosteroids are effective for many ASUC patients, but up to one-third are steroid-refractory.
- Rescue medical therapy with ciclosporin or infliximab is effective in most steroid-refractory cases when managed by experienced physicians.
- Surgery is sometimes unavoidable and occasionally the preferred treatment, with ileal pouch-anal anastomosis offering an alternative to permanent ileostomy but with functional considerations.
Conclusions:
- Well-timed rescue medical therapy offers a safe and effective alternative to surgery for many patients with steroid-refractory ulcerative colitis.
- Surgical intervention remains a critical option for select patients, and long-term functional outcomes of ileal pouch-anal anastomosis require careful consideration.
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