Management of acute severe ulcerative colitis.
Ulcerative colitis is a chronic relapsing and remitting inflammatory disorder that can generally be managed successfully with maintenance oral medications. However, approximately 15% of patients with ulcerative colitis will develop a severe exacerbation and require hospitalization. While many patients with acute severe ulcerative colitis will respond to a short course of intravenous corticosteroids, up to a third will fail to improve. In these patients with steroid-refractory colitis, the choice is between rescue medical therapy with ciclosporin or infliximab, or surgery. Well-timed rescue medical therapy is generally safe when administered by experienced physicians, and is effective in the majority of cases. Surgery is unavoidable in some cases, but is the treatment of choice in others. While ileal pouch-anal anastomosis offers the prospect of life without a permanent ileostomy, there are issues with its long-term functional outcome.
Doherty
Glen A
GA
Center for Inflammatory Bowel Disease, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA. gdoherty@bidmc.harvard.edu
Cheifetz
Adam S
AS
D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D002985:Clinical Protocols; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D039021:Colonic Pouches; D016572:Cyclosporine / Q000627:therapeutic use; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D004351:Drug Resistance; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab; D018579:Patient Selection; D016737:Proctocolectomy, Restorative; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D016572:Cyclosporine; D000069285:Infliximab