Management of acute severe ulcerative colitis (NICE CG 166)

Abstract

Ulcerative colitis (UC) presents as an acute severe flare in 10-15% of new cases and it occurs in 15% of patients with established disease. Acute severe UC can lead to significant morbidity and mortality in predominantly younger patients without other comorbidities. Inpatient hospital admission and a multidisciplinary approach are vital in appropriate and timely management. Important but simple aspects in the initial work-up and treatment of such patients are frequently overlooked during the acute medical take. An overview of the general and more specialist management of this important presentation are discussed herein.

Correlation between fecal calprotectin, ulcerative colitis endoscopic index of severity and clinical outcome in patients with acute severe colitis

“…Approximately 30-40% of ASC patients are unable to achieve clinical remission even with standard venous corticosteroid therapy (18). Selecting appropriate objective indicators to monitor changes in the patient's condition, together with timely, effective conversion of treatment strategies can reduce the risk of death in ASC patients and improve the success rate of salvage treatment or surgery (3,19,20). For ASC, clinical symptoms cannot fully reflect the activity of the disease.…”

“…Obvious bleeding observed in the lumen, or mucosal severe bleeding (3) oozing seen after flushing the lumen, or the mucosa of active bleeding was observed.…”

“…In patients with ASC, intravenous glucocorticoids remain the basic treatment. When corticosteroid cannot control the disease, the treatment strategy should be adjusted in time to salvage treatment or surgical treatment (3). Delay in treatment increases the risk of treatment and surgical complications in ASC patients, and increases the financial burden of patients (4).…”

Colitis and Crohn’s Foundation (India) consensus statements on use of 5-aminosalicylic acid in inflammatory bowel disease

“…Acute severe UC is a medical emergency with high mortality. Intravenous corticosteroids remain the cornerstone of treatment, as they act rapidly and are effective in up to 70% of the patients [ 47 , 48 ]. 5-ASAs can be temporarily withdrawn while the patients are being treated with intravenous corticosteroids, as there is no evidence supporting benefit of these drugs in acute severe UC.…”

“…5-ASAs can be temporarily withdrawn while the patients are being treated with intravenous corticosteroids, as there is no evidence supporting benefit of these drugs in acute severe UC. Conversely, a paradoxical increase in diarrhea has been reported in 3% patients on 5-ASAs [ 48 , 49 ]. However, topical 5-ASA or corticosteroids may be added in patients who have high stool frequency [ 20 ].…”