title: [Management of severe ulcerative colitis: An up-to-date].
abstract: Ulcerative Colitis (UC) is a chronic inflammatory disease involving the colon, with alternating periods of remission and activity. Exacerbations can be severe and associated with complications and mortality. Diagnosis of severe UC is based on clinical, biochemical and endoscopic variables. Patients with severe UC must be hospitalized. First line therapy is the use of intravenous corticoids which achieve clinical remission in most patients. However, 25% of patients will be refractory to corticoids, situation that should be evaluated at the third day of therapy. In patients without response, cytomegalovirus infection must be quickly ruled out to escalate to second line therapy with biological drugs or cyclosporine. Total colectomy must not be delayed if there is no response to second line therapy, if there is a contraindication for second line therapies or there are complications such as: megacolon, perforation or massive bleeding. An active management with quick escalation on therapy allows to decrease the prolonged exposure to corticoids, reduce colectomy rates and its perioperative complications.
authors.affiliation: Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Cristian
authors.initials: C
authors.lastname: Hernández-Rocha
authors.affiliation: Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Patricio
authors.initials: P
authors.lastname: Ibáñez
authors.affiliation: Unidad de Coloproctología, Departamento de Cirugía Digestiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: María Elena
authors.initials: ME
authors.lastname: Molina
authors.affiliation: Departamento de Nutrición, Diabetes y Metabolismo, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Julieta
authors.initials: J
authors.lastname: Klaassen
authors.affiliation: Departamento de Nutrición, Diabetes y Metabolismo, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Andrea
authors.initials: A
authors.lastname: Valenzuela
authors.affiliation: Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Roberto
authors.initials: R
authors.lastname: Candia
authors.affiliation: Unidad de Coloproctología, Departamento de Cirugía Digestiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Felipe
authors.initials: F
authors.lastname: Bellolio
authors.affiliation: Unidad de Coloproctología, Departamento de Cirugía Digestiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Zúñiga
authors.affiliation: Unidad de Coloproctología, Departamento de Cirugía Digestiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Miguieles
authors.affiliation: Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Juan Francisco
authors.initials: JF
authors.lastname: Miquel
authors.affiliation: Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: José
authors.initials: J
authors.lastname: Chianale
authors.affiliation: Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Manuel
authors.initials: M
authors.lastname: Álvarez-Lobos
mesh_terms: D002908:Chronic Disease; D003093:Colitis, Ulcerative / Q000000981:diagnostic imaging / Q000628:therapy*; D019723:Endoscopes; D005260:Female; D006801:Humans; D012307:Risk Factors; D012720:Severity of Illness Index