Abstract:All patients with UCEIS > 6 and Day 3 FC > 1000 µg/g failed iv corticosteroids. The UCEIS score on admission and Day 3 FC are early predictors of failure of ivcorticosteroid therapy.
“…ASC is the extreme end of the spectrum of disease severity in UC and occurs when this inflammation spills beyond the intestine and manifests in the form of elevated ESR, fever, tachycardia, and anemia, and these features form the part of Truelove and Witt's criteria 11 for diagnosis of ASC. In this severe subgroup of UC as well, the extent of severity can predict short-term outcomes as shown in the landmark paper, which led to the development of Oxford criteria, 16 and by us in a recent study, 17 in which fecal calprotectin could predict short-term outcomes in ASC. Regarding long-term outcomes in ASC, the only factor that is consistent across all studies is the response to intravenous steroids at day 7, 2,3 and this in turn depends on the severity of ASC at index admission.…”
Background and AimThe extent of disease of ulcerative colitis (UC) has been found to be a predictor of acute severe colitis (ASC), but it is unclear whether the extent of disease at the index episode of ASC is a predictor of long‐term outcome.MethodsHospitalized patients satisfying Truelove and Witts’ criteria under follow‐up at a single center from January 2003 to December 2016 were included. The extent of disease at index ASC was classified according to the Montreal classification as left‐sided or extensive colitis. Extent was used to predict the long‐term risk of colectomy or steroid dependence following an index episode of ASC.ResultsOf 2076 patients with ulcerative colitis, 241 (12%) had an index episode of ASC. In total, 34 (14%) patients underwent a colectomy at index admission and 53 (26%) over a median follow‐up of 48(1–172) months. Left‐sided colitis and extensive colitis did not differ in the rate of colectomy at index admission (12% vs 15%, P = 0.4) and colectomy in follow‐up (31% vs 23%, P = 0.17). Readmission due to ASC was also similar between the two groups (28% vs 32%, P = 0.6).ConclusionExtent of disease at index ASC does not predict colectomy at admission and over the long term.
“…ASC is the extreme end of the spectrum of disease severity in UC and occurs when this inflammation spills beyond the intestine and manifests in the form of elevated ESR, fever, tachycardia, and anemia, and these features form the part of Truelove and Witt's criteria 11 for diagnosis of ASC. In this severe subgroup of UC as well, the extent of severity can predict short-term outcomes as shown in the landmark paper, which led to the development of Oxford criteria, 16 and by us in a recent study, 17 in which fecal calprotectin could predict short-term outcomes in ASC. Regarding long-term outcomes in ASC, the only factor that is consistent across all studies is the response to intravenous steroids at day 7, 2,3 and this in turn depends on the severity of ASC at index admission.…”
Background and AimThe extent of disease of ulcerative colitis (UC) has been found to be a predictor of acute severe colitis (ASC), but it is unclear whether the extent of disease at the index episode of ASC is a predictor of long‐term outcome.MethodsHospitalized patients satisfying Truelove and Witts’ criteria under follow‐up at a single center from January 2003 to December 2016 were included. The extent of disease at index ASC was classified according to the Montreal classification as left‐sided or extensive colitis. Extent was used to predict the long‐term risk of colectomy or steroid dependence following an index episode of ASC.ResultsOf 2076 patients with ulcerative colitis, 241 (12%) had an index episode of ASC. In total, 34 (14%) patients underwent a colectomy at index admission and 53 (26%) over a median follow‐up of 48(1–172) months. Left‐sided colitis and extensive colitis did not differ in the rate of colectomy at index admission (12% vs 15%, P = 0.4) and colectomy in follow‐up (31% vs 23%, P = 0.17). Readmission due to ASC was also similar between the two groups (28% vs 32%, P = 0.6).ConclusionExtent of disease at index ASC does not predict colectomy at admission and over the long term.
“…A prospective study of 90 patients with ASUC noted that faecal calprotectin (FC) was significantly higher in patients undergoing colectomy during the hospital stay, with a level >1992.5 µg/g associated with the need for colectomy over the next year 33. A recent prospective study of 49 patients from India found that all patients with UCEIS >6 on admission and FC >1000 µg/g on day 3 failed steroid therapy 17. These new indices without stool frequency, if validated, would provide an objective measure of risk of steroid failure.…”
Acute severe ulcerative colitis is a life-threatening medical emergency, which can be associated with significant morbidity and is preventable through prompt and effective management. Corticosteroids remain the cornerstone of initial therapy, although a third of patients will not respond. Further management hinges on timely decisions with use of rescue therapy with ciclosporin or infliximab, without compromising the health or safety of the patient, or timely surgery. Although such patients need specialist care, it is imperative that emergency care physicians are aware of the important principles of management of this condition to achieve successful outcomes. Risk stratification and the use of predictive models using clinical parameters have reduced the morbidity associated with this condition.We discuss current evidence and present a clinical approach to clinicians involved in the emergency care of patients with acute severe ulcerative colitis in this review.
“…In a recently published study , an ulcerative colitis endoscopic index of severity (UCEIS) score of more than six on admission and faecal calprotectin > 1000 μg/g on day three were found to be early predictors of failure of intravenous corticosteroid therapy and the need for rescue therapy or colectomy.…”
Aim
There is a requirement of an expansive and up to date review of surgical management of inflammatory bowel disease (IBD) that can dovetail with the medical guidelines produced by the British Society of Gastroenterology.
Methods
Surgeons who are members of the ACPGBI with a recognised interest in IBD were invited to contribute various sections of the guidelines. They were directed to produce a procedure based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. An editorial board was convened to ensure consistency of style, presentation and quality. Each author was asked to provide a set of recommendations which were evidence based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after 2 votes were included in the guidelines.
Results
All aspects of surgical care for IBD have been included along with 157 recommendations for management.
Conclusion
These guidelines provide an up to date and evidence based summary of the current surgical knowledge in the management of IBD and will serve as a useful practical text for clinicians performing this type of surgery.
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