Historical evolution of the management of severe ulcerative colitis

Ulcerative colitis was first described in 1859, but it was not until the early 20th century that it became a well recognized clinical entity. The patients of the old series showed high mortality rate ranging from 30% in the severe forms to 60% in the fulminating forms. The introduction of corticosteroids in the 1950s dramatically improved the prognosis of patients with severe ulcerative colitis. The strategy based on intensive medical treatment, early detection of risk factors and early surgery progressively reduced the mortality rate to less than 1%. Tachycardia, fever, reduced number of intestinal sounds, hypoalbuminaemia, hypokalaemia metabolic alkalosis and elevated C-reactive protein were recognized to be the most useful risk factors. Plain abdominal X-ray remains the very reliable suitable tool to detect early complications of severe colitis. Once reduced the mortality near to zero, treatment has been addressed to avoid colectomy. Cyclosporine and Infliximab are currently used as rescue therapy, however, despite the high remission rates achieved with both drugs, about 50% of the treated patients ultimately will come to colectomy over the next few years.