The management of severe ulcerative colitis

Abstract

Severe ulcerative colitis is a potentially life‐threatening condition but the mortality has fallen dramatically over the past 30–40 years. It is now less than 2%, including surgical mortality, and should only be seen in patients with significant co‐existing disease. Early recognition of the severity of the colitis, intensive medical therapy, close liaison between physician and surgeon, and prompt surgery when necessary have all contributed to this improved outcome. Despite the use of high‐dose intravenous corticosteroids, 20–30% of patients will make a poor response and will require urgent surgery. The use of intravenous cyclosporin has proved effective at reducing the immediate surgical rate in this group of unresponsive patients and appears safe. Whether cyclosporin reduces the need for surgery in the longer term is much less certain. Clinical, radiological, endoscopic and laboratory parameters can now be used to predict the course of a severe attack. These help in the timing of urgent surgery and are potentially helpful in determining when to begin other therapies such as cyclosporin.

Evaluation of the clinical course of acute attacks in patients with ulcerative colitis through the use of an activity index

“…7 Indeed, many clinicians may continue medical therapy for 10 days or more in patients in whom there is some evidence of continued improvement. 24 The present study showed that patients with an AI value in excess of 200 after 2 weeks of medical therapy had a high chance of undergoing colectomy. This cutoff value also seemed to be valid for both sensitivity and specificity.…”

Risk Factors and Indications for Colectomy in Ulcerative Colitis Patients are Different According to Patient's Clinical Background

“…The cumulative colectomy rate among patients with UC has been reported at 8 to 20 percent and 11 to 28 percent at five and ten years after onset, respectively. [3][4][5][6] Recently, proctocolectomy and reconstruction with an ileal pouch-anal anastomosis has become the leading surgical procedure for patients with UC and has provided both acceptable function and quality of life. 7,8 However, there are many complications associated with this surgical procedure, such as pelvic sepsis, high stool frequency, fecal incontinence, evacuation disorders, and pouch failure.…”

Infliximab three-dose induction regimen in severe corticosteroid-refractory ulcerative colitis: Early and late outcome and predictors of colectomy

“…Early recognition of prognostic factors, intensive medical therapy, and early surgery for non-responders have all contributed to improved outcome. 2 In spite of the use of intensive intravenous glucocorticoid treatment (IIVT), approximately 20-30% of patients fail to respond and will require surgery. The short term colectomy rate has remained stable during the last 30 years 3 ; moreover, approximately one third of patients who escape early colectomy will require surgery in the long term, for a further severe attack or for frequent relapsing disease.…”