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Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection
Published on: December 8, 2014
Review article: the management of severe ulcerative colitis
1Radcliffe Infirmary, Oxford, UK.
Alimentary Pharmacology & Therapeutics
|June 1, 1997
Summary
Severe ulcerative colitis outcomes have improved, with mortality now under 2%. Early recognition, intensive medical therapy, and timely surgery are key. Cyclosporin may reduce immediate surgical needs in non-responders.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Immunosuppressive Therapy
Background:
- Severe ulcerative colitis (UC) presents a significant health risk, historically associated with high mortality rates.
- Recent decades have seen a dramatic reduction in UC-related mortality, now below 2%, largely due to advancements in care.
- Improved outcomes are attributed to early severity assessment, aggressive medical management, physician-surgeon collaboration, and prompt surgical intervention when indicated.
Purpose of the Study:
- To review the factors contributing to improved outcomes in severe ulcerative colitis.
- To evaluate the role of intravenous cyclosporin in managing patients with severe UC unresponsive to corticosteroids.
- To discuss the utility of clinical, radiological, endoscopic, and laboratory parameters in predicting disease course and guiding treatment decisions.
Main Methods:
- Review of historical and current treatment strategies for severe ulcerative colitis.
- Analysis of outcomes data, including mortality rates and surgical intervention rates.
- Evaluation of the efficacy and safety of intravenous cyclosporin in a subset of UC patients.
- Assessment of predictive parameters for severe ulcerative colitis attacks.
Main Results:
- Mortality for severe ulcerative colitis has decreased to less than 2%, primarily in patients without significant comorbidities.
- Approximately 20-30% of severe UC patients show a poor response to high-dose intravenous corticosteroids, necessitating urgent surgery.
- Intravenous cyclosporin has demonstrated effectiveness in reducing the immediate surgical rate for corticosteroid-unresponsive patients, with an acceptable safety profile.
- Predictive parameters are available to guide the timing of surgery and the initiation of therapies like cyclosporin.
Conclusions:
- Advances in early recognition, intensive medical therapy, and surgical management have significantly improved survival rates in severe ulcerative colitis.
- Intravenous cyclosporin offers a valuable option for managing acute severe ulcerative colitis unresponsive to corticosteroids, reducing the need for immediate surgery.
- Predictive clinical, radiological, endoscopic, and laboratory markers aid in optimizing treatment timing and therapeutic choices for severe ulcerative colitis.
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