Managing acute severe ulcerative colitis in the hosptialised setting

Area of Science:

• Gastroenterology
• Internal Medicine

Background:

• Ulcerative colitis (UC) is a common inflammatory bowel disease (IBD) in the UK.
• Acute severe ulcerative colitis (ASUC) affects 1 in 10 UC patients, with significant colectomy (27%) and mortality (1%) rates despite current treatments.
• Intravenous corticosteroids are standard, but one-third of patients do not respond.

Purpose of the Study:

• To review evidence for conventional management of ASUC.
• To highlight the importance of early recognition and intervention in ASUC.
• To discuss rescue therapy options and factors influencing colectomy-free survival.

Main Methods:

• Review of published evidence on acute severe ulcerative colitis management.
• Application of Travis criteria for early identification of non-responders.
• Analysis of rescue therapy efficacy (infliximab, ciclosporin) and thiopurine exposure impact.

Main Results:

• Travis criteria aid early identification of non-responsive ASUC patients.
• Rescue therapy with infliximab or ciclosporin shows comparable efficacy.
• Patients not previously treated with thiopurines demonstrate better colectomy-free survival post-rescue therapy.

Conclusions:

• Early recognition and intervention are crucial for managing ASUC.
• Rescue therapies offer effective options for non-responders to corticosteroids.
• Thiopurine naivety is associated with improved outcomes following rescue therapy in ASUC.