An approach to acute severe ulcerative colitis

ABSTRACT

Introduction: Despite the introduction of novel therapies and treatment strategies for ulcerative colitis (UC), many patients develop acute, severe episodes, warranting prompt care and aggressive management. There is a significant unmet need to improve outcomes in these patients. Clinicians must be able to identify those that will have worse prognosis and plan an aggressive therapy with an early/proactive adjustments in management if needed.

Areas covered: The aim of this review is to evaluate the most recent evidence on the assessment and management of patients with acute severe ulcerative colitis. We searched the mainstream literature search engines for the most recent evidence on diagnosis and management of acute UC.

Expert Opinion: The approach to patients with severe UC includes clinical and endoscopic assessment of disease severity and ruling out over-infections. While intravenous corticosteroids remain the first line therapy for acute severe colitis, many patients do not respond and require escalation to calcineurin inhibitors or infliximab, and may ultimately require colectomy. Even though several novel therapies are available or in development, their role in acute severe episodes of colitis is unknown.

KEYWORDS:

• Ulcerative colitis
• infliximab
• calcineurin inhibitors
• corticosteroids
• acute severe ulcerative colitis

Declaration of interest

A. Yarur has received consultancy honoraria from Takeda and Prometheus Labs.The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Article highlights

• The clinical evaluation of acute severe ulcerative colitis (ASUC) must include disease severity, close monitoring of the patient and early adequate therapy as well as prevention of complications.

• Cyclosporine and Infliximab seem equally effective treatments for ASCUS. However, the decision of choosing one over the other should be made based on the patient’s medical history, site expertise and the availability/feasibility of long term-therapies.

• The decision among usage of infliximab in standard or accelerated scheme must be made patient to patient, with early adjustment of treatment if needed.

• Sequential therapy with infliximab or calcineurin inhibitors can be considered in some patients but requires an experienced medical team to carry it through.

• The role of novel therapies in ASCUS such as tofacitinib is unclear and warrants further studies.

Additional information

Funding

This paper was not funded.