title: Acute severe ulcerative colitis: from pathophysiology to clinical management.
abstract: Ulcerative colitis is a common chronic inflammatory disease of the colon and rectum, resulting from a dysregulated immune response towards intraluminal antigens in a genetically predisposed host. The disease has a varying extent and severity. Approximately 20% of patients with ulcerative colitis experience a severe flare during the course of their disease, requiring hospitalization. Acute severe ulcerative colitis (ASUC) is potentially a life-threatening condition that requires early recognition, hospitalization, correction of body fluids and electrolytes, and nutritional support if needed. Superimposed bacterial or viral infections need to be excluded and thromboprophylaxis should be started. Intravenous corticosteroids are the first-line treatment for this condition. Rescue treatment with ciclosporin or infliximab is indicated in patients who do not sufficiently respond to corticosteroids after 3-5 days, with close monitoring of the patients' symptoms, serum C-reactive protein and albumin levels. If medical therapy fails, timely colectomy should be performed to prevent critical complications. In this article, we review all relevant aspects of ASUC, from its pathophysiological background to modern management in clinical practice.
authors: Department of Gastroenterology, University Hospital of Ghent, De Pintelaan 185, 9000 Ghent, Belgium.|Department of Gastroenterology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, Netherlands.|Robarts Clinical Trials, 100 Dundas Street, N6A 5B6 London, Ontario, Canada.
authors: Pieter
authors: P
authors: Hindryckx
authors: Department of Medicine, Division of Gastroenterology, University Hospital, 339 Windermere Road, N6A 5A5 London, Ontario, Canada.|Robarts Clinical Trials, 100 Dundas Street, N6A 5B6 London, Ontario, Canada.
authors: Vipul
authors: V
authors: Jairath
authors: Department of Gastroenterology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, Netherlands.|Robarts Clinical Trials, 100 Dundas Street, N6A 5B6 London, Ontario, Canada.
authors: Geert
authors: G
authors: D'Haens
mesh_terms: D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000465:Algorithms; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D065095:Calcineurin Inhibitors / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D003113:Colonoscopy; D016572:Cyclosporine / Q000627:therapeutic use; D004195:Disease Models, Animal; D004573:Electrolytes / Q000008:administration & dosage; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use; D010288:Parenteral Nutrition; D016879:Salvage Therapy / Q000379:methods; D013923:Thromboembolism / Q000517:prevention & control; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000276:immunology
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000911:Antibodies, Monoclonal; D065095:Calcineurin Inhibitors; D004573:Electrolytes; D014409:Tumor Necrosis Factor-alpha; D016572:Cyclosporine; D000069285:Infliximab