title: Treatment of hospitalized adult patients with severe ulcerative colitis: Toronto consensus statements.
abstract: OBJECTIVE
  The objective of this study was to provide updated explicit and relevant consensus statements for clinicians to refer to when managing hospitalized adult patients with acute severe ulcerative colitis (UC).
  
  
  METHODS
  The Canadian Association of Gastroenterology consensus group of 23 voting participants developed a series of recommendation statements that addressed pertinent clinical questions. An iterative voting and feedback process was used to do this in conjunction with systematic literature reviews. These statements were brought to a formal consensus meeting held in Toronto, Ontario (March 2010), when each statement was discussed, reformulated, voted upon, and subsequently revised until group consensus (at least 80% agreement) was obtained. The modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria were used to rate the strength of recommendations and the quality of evidence.
  
  
  RESULTS
  As a result of the iterative process, consensus was reached on 21 statements addressing four themes (General considerations and nutritional issues, Steroid use and predictors of steroid failure, Cyclosporine and infliximab, and Surgical issues).
  
  
  CONCLUSIONS
  Key recommendations for the treatment of hospitalized patients with severe UC include early escalation to second-line medical therapy with either infliximab or cyclosporine in individuals in whom parenteral steroids have failed after 72 h. These agents should be used in experienced centers where appropriate support is available. Sequential therapy with cyclosporine and infliximab is not recommended. Surgery is an option when first-line steroid therapy fails, and is indicated when second-line medical therapy fails and/or when complications arise during the hospitalization.
authors: McGill University Health Centre, Montreal, Quebec, Canada. alain.bitton@muhc.mcgill.ca
authors: Alain
authors: A
authors: Bitton
authors: Donald
authors: D
authors: Buie
authors: Robert
authors: R
authors: Enns
authors: Brian G
authors: BG
authors: Feagan
authors: Jennifer L
authors: JL
authors: Jones
authors: John K
authors: JK
authors: Marshall
authors: Scott
authors: S
authors: Whittaker
authors: Anne M
authors: AM
authors: Griffiths
authors: Remo
authors: R
authors: Panaccione
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000601:surgery; D016572:Cyclosporine / Q000627:therapeutic use*; D006760:Hospitalization; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D000069285:Infliximab; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D000069285:Infliximab