Leukocytapheresis (LCAP) for Management of Fulminant Ulcerative Colitis with Toxic Megacolon

Sawada, Koji; Egashira, Akimitsu; Ohnishi, F; Fukunaga, Ken; Kusaka, Takeshi; Shimoyama, Takashi

doi:10.1007/s10620-005-2571-3

Cited by 29 publications

(12 citation statements)

References 35 publications

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“…Four out of six patients went into the remission stage of UC, circumventing colectomy. 82 Yet due to lack of further studies this procedure does not play a role in the recommended management of toxic megacolon.…”

Section: Medical Therapymentioning

confidence: 99%

Toxic megacolon

and

Baumgart

2012

Inflammatory Bowel Diseases

122

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Toxic megacolon represents a dreaded complication of mainly inflammatory or infectious conditions of the colon. It is most commonly associated with inflammatory bowel disease (IBD), i.e., ulcerative colitis or ileocolonic Crohn's disease. Lately, the epidemiology has shifted toward infectious causes, specifically due to an increase of Clostridium difficile-associated colitis possibly due to the extensive (ab)use of broad-spectrum antibiotics. Other important infectious etiologies include Salmonella, Shigella, Campylobacter, Cytomegalovirus (CMV), rotavirus, Aspergillus, and Entameba. Less frequently, toxic megacolon has been attributed to ischemic colitis, collagenous colitis, or obstructive colorectal cancer. Toxic colonic dilatation may also occur in hemolytic-uremic syndrome (HUS) caused by enterohemorrhagic or enteroaggregative Escherichia coli O157 (EHEC, EAEC, or EAHEC). The pathophysiological mechanisms leading to toxic colonic dilatation are incompletely understood. The main characteristics of toxic megacolon are signs of systemic toxicity and severe colonic distension. Diagnosis is made by clinical evaluation for systemic toxicity and imaging studies depicting colonic dilatation. Plain abdominal imaging is still the most established radiological instrument. However, computed tomography scanning and transabdominal intestinal ultrasound are promising alternatives that add additional information. Management of toxic megacolon is an interdisciplinary task that requires close interaction of gastroenterologists and surgeons from the very beginning. The optimal timing of surgery for toxic megacolon can be challenging. Here we review the latest data on the pathogenesis, clinical presentation, laboratory, and imaging modalities and provide algorithms for an evidence-based diagnostic and therapeutic approach.

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Section: Medical Therapymentioning

confidence: 99%

Toxic megacolon

and

Baumgart

2012

Inflammatory Bowel Diseases

122

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“…In another study, however, 26 of 33 patients maintained remission at one year after 11 weekly sessions of granulocyte/monocyte apheresis [65]. Apheresis may be effective in other settings as well, including a small group of patients with toxic megacolon [66], acute pouchitis [67] and a patient with pyoderma gangrenosum [68].…”

Section: Apheresismentioning

confidence: 99%

Current and Future Biological Treatments in Inflammatory Bowel Disease

Yamamoto‐Furusho¹

2011

Gene Therapy Applications

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“…Of 6 patients, 4 achieved clinical remission, with their average CAI decreasing from 19.5 to 1 point. The remaining 2 patients did not respond to Cellsorba apheresis and underwent colectomy [65]. …”

Section: Cellsorba Leukocytapheresis For Ulcerative Colitismentioning

confidence: 99%

Cytapheresis in Inflammatory Bowel Diseases: Current Evidence and Perspectives

Danese¹,

Angelucci²,

Stefanelli³

et al. 2008

Digestion

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Ulcerative colitis and Crohn’s disease are inflammatory bowel diseases with a chronic relapsing course. Management of both conditions is far from being fully satisfactory. For this reason in the last decade a large number of biological therapies, targeting cytokines involved in intestinal inflammation, has been developed with various results in terms of efficacy, safety and costs. Activated granulocytes and monocytes represent the major sources of pro-inflammatory cytokines in the intestinal mucosa, playing a pivotal role in inducing and maintaining intestinal inflammation. Leukocytapheresis using an adsorptive carrier-based system (Adacolumn®) or a removal filter column (Cellsorba®) has been proposed as a feasible, safe and effective therapy for ulcerative colitis and Crohn’s disease. The objective of this paper is to provide an overview on the current knowledge about mechanisms of action, available clinical data and the possible future perspectives for the use of Adacolumn and Cellsorba in the management of inflammatory bowel diseases.

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Leukocytapheresis (LCAP) for Management of Fulminant Ulcerative Colitis with Toxic Megacolon

Cited by 29 publications

References 35 publications

Toxic megacolon

Toxic megacolon

Current and Future Biological Treatments in Inflammatory Bowel Disease

Cytapheresis in Inflammatory Bowel Diseases: Current Evidence and Perspectives

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