Combination Treatment with Antibiotics and Glucocorticosteroids for Severe Ischemic Colitis

Abstract

Background/Aims: Ischemic colitis (IC) is most common in the elderly and patients with multiple comorbidities. It carries significant mortality. As yet no evidence-based therapeutic management exists. Aim of the study was to test therapeutic efficacy of a combination of prednisolone and antibiotics. Methods: Prospective cohort study with retrospective analysis performed in a single teaching hospital in Germany. Consecutive patients with strict diagnostic criteria of severe IC, including colonoscopy, histology, and laboratory tests, were recruited. Main outcome measures were in-hospital mortality and number of operations counted within the hospital stay. Severity scores were calculated and biomarkers determined during the course of the hospital stay. Results: A total of 342 patients with an International Classification of Diseases of IC were identified. About 151 patients met the diagnostic criteria and a total of 44 patients fulfilled all inclusion and exclusion criteria of severe IC and constituted the group of patients eligible for analysis. Five out of 44 patients (11.4%) died (in-hospital mortality). Surgery was performed in 3 patients (6.8%), 2 patients survived. The hospital stay lasted 14.0 ± 8.5 day and was significantly correlated with comorbidity (r s = 0.314, p = 0.038). No serious adverse events were observed. Conclusion: This is the first prospective study on therapeutic efficacy and safety in severe IC. The combination of intravenous antibiotics and intravenous prednisolone turned out to be safe and revealed promising efficacy.

Diagnostic methods and drug therapies in patients with ischemic colitis

“…However, Wolfgang Kruis et al recently suggested a potential protective effect of the combination of intravenous antibiotics and intravenous prednisolone for cases of severe IC. This preliminary study may offer a new pathway for the field of study of conservative management of severe IC [67]; however, this result still needs further exploration.…”

Congestive ischemic colitis successfully treated with anti-inflammatory therapy: A case report

“…However, recovery may be protracted with bowel rest alone, and surgical intervention may be necessary in some severe cases. Kruis and Schiff[ 10 ] reported that combination therapy with intravenous antibiotics and prednisolone showed promising therapeutic effects without safety concerns in cases of moderate-to-severe ischemic colitis. Antimicrobial therapy can effectively reduce pathogenic bacteria, bacterial translocation, and inflammatory responses to ischemic injury[ 1 , 8 ].…”

Necroptosis Contributes to LPS-Induced Activation of the Hypothalamic-Pituitary-Adrenal Axis in a Piglet Model

“…The HPA axis is a complex regulatory system with direct and feedback interaction composed of the hypothalamus, pituitary gland, and adrenal gland. The HPA axis is an integral part of the neuro-endocrine system, involved in controlling responses to stress or infection and serving to restore the homeostasis, and regulating a variety of physical activities, immune system, emotion, and digestion [ 19 , 20 ]. When the body is exposed to stressors, various cytokines (such as TNF-α, IL-1β, and IL-6) secreted by immune cells act as critical molecular signals that trigger the activation of HPA axis [ 3 ].…”