Severe ulcerative colitis: a personal point of view.

Area of Science:

• Gastroenterology
• Internal Medicine
• Colorectal Surgery

Background:

• Ulcerative colitis (UC) is a chronic inflammatory bowel disease.
• Approximately 15% of UC patients experience severe attacks with systemic toxicity.
• These severe attacks, termed toxic colitis, are associated with significant morbidity and mortality.

Purpose of the Study:

• To analyze the determinants of severity and mortality in patients with severe ulcerative colitis.
• To identify reliable indicators of disease activity and prognosis.
• To evaluate the optimal timing for surgical intervention in toxic colitis.

Main Methods:

• Review of literature on severe ulcerative colitis.
• Analysis of a series of 46 patients with severe ulcerative colitis.
• Assessment of clinical presentation, laboratory findings (including C-reactive protein), and abdominal plain film radiography.

Main Results:

• 28 out of 46 patients experienced "fulminating" or "toxic" colitis, leading to a 4.3% mortality rate.
• Disease severity correlates with the depth and extent of colonic inflammation.
• C-reactive protein is a reliable marker for disease activity and lesion extension.
• Abdominal X-rays showing increased small intestinal gas and air-fluid levels indicate high risk, even without megacolon.

Conclusions:

• Toxic colitis is a major determinant of complications and mortality in ulcerative colitis.
• C-reactive protein and specific radiographic findings are crucial for assessing patient risk.
• A brief period of medical management (72-120 hours) is recommended to rule out infection, optimize patient condition, and guide surgical decisions.