34. Acute severe ulcerative colitis

Ulcerative colitis is a chronic inflammatory bowel disease, usually diagnosed in early adulthood.14,15 The hallmark symptoms include bloody diarrhea, rectal urgency and pain, cramping, and feeling unable to completely empty the bowel, even after defecation.1 Ulcerative colitis is defined based on disease location: proctitis (limited to the rectum), left-sided disease (limited to descending colon and rectum), and extensive disease (entire colon).14 Most patients with ulcerative colitis have proctitis or left-sided disease. Only about 10% to 30% of patients have extensive disease.15 Most patients with ulcerative colitis are classified as having mild to moderate disease.14,15 However, up to 15% of patients have moderate to severe disease.15 Up to one in four patients with ulcerative colitis require hospitalization for acute severe ulcerative colitis.1,12 The chart below answers common questions about the management of acute severe ulcerative colitis in adults.

[1]  P. Dulai,et al.  Acute severe ulcerative colitis: latest evidence and therapeutic implications , 2018, Therapeutic advances in chronic disease.

[2]  Siddharth Singh,et al.  Natural History of Adult Ulcerative Colitis in Population‐based Cohorts: A Systematic Review , 2017, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[3]  W. Saliba,et al.  Role of antibiotics for treatment of inflammatory bowel disease. , 2016, World journal of gastroenterology.

[4]  Siddharth Singh,et al.  Treatment and prevention of pouchitis after ileal pouch-anal anastomosis for chronic ulcerative colitis. , 2019, The Cochrane database of systematic reviews.

[5]  P. Rutgeerts,et al.  Vedolizumab as induction and maintenance therapy for ulcerative colitis. , 2013, The New England journal of medicine.

[6]  G. Radford-Smith,et al.  Outcomes of salvage therapy for steroid‐refractory acute severe ulcerative colitis: ciclosporin vs. infliximab , 2013, Alimentary pharmacology & therapeutics.

[7]  J. Gisbert,et al.  Ciclosporin versus infliximab in patients with severe ulcerative colitis refractory to intravenous steroids: a parallel, open-label randomised controlled trial , 2012, The Lancet.

[8]  John T. Chang,et al.  Strategies for the care of adults hospitalized for active ulcerative colitis. , 2012, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[9]  T. Hibi,et al.  Randomized , Double-Blind , Sham-Controlled Study of ranulocyte / Monocyte Apheresis for Active Ulcerative Colitis , 2008 .

[10]  W. Cacheux,et al.  Predictive Factors of Response to Cyclosporine in Steroid-Refractory Ulcerative Colitis , 2008, The American Journal of Gastroenterology.

[11]  M. Regueiro,et al.  A phase I study of visilizumab, a humanized anti-CD3 monoclonal antibody, in severe steroid-refractory ulcerative colitis. , 2007, Gastroenterology.

[12]  J. Halfvarson,et al.  Long-Term Colectomy Rate After Intensive Intravenous Corticosteroid Therapy for Ulcerative Colitis Prior to the Immunosuppressive Treatment Era , 2007, The American Journal of Gastroenterology.

[13]  A. Gasbarrini,et al.  Infliximab in severe ulcerative colitis: short‐term results of different infusion regimens and long‐term follow‐up , 2007, Alimentary pharmacology & therapeutics.

[14]  S. Xiao,et al.  Meta‐analysis: the utility and safety of heparin in the treatment of active ulcerative colitis , 2007, Alimentary pharmacology & therapeutics.

[15]  S. Danese,et al.  Inflammation and Coagulation in Inflammatory Bowel Disease: The Clot Thickens , 2007, The American Journal of Gastroenterology.

[16]  A. Griffiths,et al.  Response to corticosteroids in severe ulcerative colitis: a systematic review of the literature and a meta-regression. , 2007, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[17]  H. Bachelez.  [Infliximab: remicade]. , 2007, Annales de dermatologie et de venereologie.

[18]  T. Matsui,et al.  A randomised dose finding study of oral tacrolimus (FK506) therapy in refractory ulcerative colitis , 2006, Gut.

[19]  N. Shepherd,et al.  Basiliximab for the treatment of steroid‐resistant ulcerative colitis: further experience in moderate and severe disease , 2006, Alimentary pharmacology & therapeutics.

[20]  S. Targan,et al.  Daclizumab, a humanised monoclonal antibody to the interleukin 2 receptor (CD25), for the treatment of moderately to severely active ulcerative colitis: a randomised, double blind, placebo controlled, dose ranging trial , 2006, Gut.

[21]  Simon Smale,et al.  Prevalence and mechanism of nonsteroidal anti-inflammatory drug-induced clinical relapse in patients with inflammatory bowel disease. , 2006, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[22]  Å. Danielsson,et al.  Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo-controlled study. , 2005, Gastroenterology.

[23]  H. Hanai,et al.  CASE REPORT: Therapeutic Efficacy of Granulocyte and Monocyte Adsorption Apheresis in Severe Active Ulcerative Colitis , 2002, Digestive Diseases and Sciences.

[24]  P. Rutgeerts,et al.  Randomized, double-blind comparison of 4 mg/kg versus 2 mg/kg intravenous cyclosporine in severe ulcerative colitis. , 2003, Gastroenterology.

[25]  L. Mortelmans,et al.  Intravenous cyclosporine versus intravenous corticosteroids as single therapy for severe attacks of ulcerative colitis. , 2001, Gastroenterology.

[26]  D. Jewell,et al.  Predicting outcome in severe ulcerative colitis. , 1996, Gut.

[27]  D. Jewell,et al.  Intensive intravenous regimen for severe attacks of ulcerative colitis. , 1974, Lancet.

[28]  S. Truelove,et al.  Cortisone in Ulcerative Colitis , 1954 .