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Acute severe ulcerative colitis: latest evidence and therapeutic implications
Parambir S Dulai1, Vipul Jairath2
1Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA.
Therapeutic Advances in Chronic Disease
|February 2, 2018
Summary
Acute severe ulcerative colitis (ASUC) flares require prompt treatment. For patients not responding to steroids, infliximab (IFX) or cyclosporine (CsA) rescue therapy is crucial, though optimal IFX dosing needs further study.
Area of Science:
- Gastroenterology
- Immunology
- Internal Medicine
Background:
- Ulcerative colitis (UC) is a chronic inflammatory bowel disease affecting the colorectum.
- Acute flares necessitate hospitalization and multidisciplinary management.
- One-fifth of UC patients experience severe flares requiring emergency intervention.
Purpose of the Study:
- To review management strategies for acute severe ulcerative colitis (ASUC).
- To discuss medical rescue therapies including infliximab (IFX) and cyclosporine (CsA).
- To highlight uncertainties in IFX dosing and the role of colectomy.
Main Methods:
- Review of current literature on ASUC management.
- Analysis of treatment pathways for steroid-refractory patients.
- Discussion of surgical intervention indications.
Main Results:
- Medical rescue therapy with IFX or CsA is indicated for steroid-refractory ASUC.
- Optimal IFX induction dosing strategies require further investigation via prospective studies.
- Colectomy is indicated for non-responders to medical rescue therapy or fulminant colitis.
Conclusions:
- Prompt recognition and multidisciplinary management are key for ASUC.
- While IFX and CsA are vital, optimal dosing and long-term outcomes require more research.
- Half of ASUC patients may require colectomy within five years, indicating a suboptimal long-term prognosis.
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