Modern practical management of acute severe colitis

Area of Science:

• Gastroenterology
• Internal Medicine
• Clinical Pharmacology

Background:

• Acute severe ulcerative colitis (ASUC) is a life-threatening complication affecting 20% of ulcerative colitis (UC) patients.
• It has high morbidity and up to 1% mortality, with no validated scoring systems.
• Steroid refractoriness occurs in one-third of ASUC patients, necessitating colectomy or salvage therapy.

Purpose of the Study:

• To review current evidence-based practices for ASUC management.
• To identify gaps in knowledge regarding ASUC treatment.
• To explore unmet needs in therapeutic options, especially for steroid-refractory patients.

Main Methods:

• Literature review of current best evidence for ASUC management.
• Analysis of existing therapeutic strategies and their limitations.
• Identification of potential alternative and salvage therapies.

Main Results:

• Intravenous corticosteroids are the primary treatment, but one-third of patients are refractory.
• Current predictors of non-response to steroids and salvage therapies are suboptimal.
• Infliximab and cyclosporine are effective salvage therapies but have failure rates.

Conclusions:

• There is a significant unmet need for improved predictors of treatment response in ASUC.
• Alternative therapeutic options, including small molecules and biologics, are needed before colectomy.
• Development of clear outcome measures for ASUC patients is essential.