Medical treatment of severe ulcerative colitis

Daperno, Marco; Sostegni, R.; Rocca, Rodolfo; Rigazio, C.; Scaglione, Nadia; Castellino, F.; Ercole, E.; Pera, A.

doi:10.1046/j.1365-2036.16.s4.2.x

Cited by 48 publications

(27 citation statements)

References 35 publications

(39 reference statements)

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“…Exacerbations requiring hospitalisation, therefore, might be expected to occur more frequently in children, but this burden of illness among paediatric patients has not been previously assessed. It is generally accepted that the lifetime risk of acute severe ulcerative colitis among adult patients is approximately 15% 24 – 26. As hypothesised, we have documented a greater likelihood of hospitalisation for treatment of acute disease in our paediatric population-based cohort.…”

Section: Discussionsupporting

confidence: 57%

Severe paediatric ulcerative colitis: incidence, outcomes and optimal timing for second-line therapy

Turner

Walsh

Benchimol

et al. 2008

Gut

161

125

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Section: Discussionsupporting

confidence: 57%

Severe paediatric ulcerative colitis: incidence, outcomes and optimal timing for second-line therapy

Turner

Walsh

Benchimol

et al. 2008

Gut

161

125

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“…Other measures for the management of acute severe colitis in addition to IV corticosteroids are: 4,5,124 …”

Section: Resultsmentioning

confidence: 99%

The Asia‐Pacific consensus on ulcerative colitis

Ooi

Fock

Makharia

et al. 2010

J of Gastro and Hepatol

140

101

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Inflammatory bowel disease (IBD) is increasing in many parts of the Asia-Pacific region. There is a need to improve the awareness of IBD and develop diagnostic and management recommendations relevant to the region. This evidence-based consensus focuses on the definition, epidemiology and management of ulcerative colitis (UC) in Asia.A multi-disciplinary group developed the consensus statements, reviewed the relevant literature, and voted on them anonymously using the Delphi method. The finalized statements were reviewed to determine the level of consensus, evidence quality and strength of recommendation.Infectious colitis must be excluded prior to diagnosing UC. Typical histology and macroscopic extent of the disease seen in the West is found in the Asia-Pacific region. Ulcerative colitis is increasing in many parts of Asia with gender distribution and age of diagnosis similar to the West. Extra-intestinal manifestations including primary sclerosing cholangitis are rarer than in the West. Clinical stratification of disease severity guides management. In Japan, leukocytapheresis is a treatment option. Access to biologic agents remains limited due to high cost and concern over opportunistic infections. The high endemic rates of hepatitis B virus infection require stringent screening before initiating immune-suppressive agents. Vaccination and prophylactic therapies should be initiated on a case-by-case basis and in accordance with local practice. Colorectal cancer complicates chronic colitis.A recent increase in UC is reported in the Asia-Pacific region. These consensus statements aim to improve the recognition of UC and assist clinicians in its management with particular relevance to the region.

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“…An estimated 15% lifetime risk of acute severe UC is reported in the adult literature. [16][17][18] Recent data from Oxford, however, suggest that the risk in adults may be actually similar to children (186 of 750 patients; 25%), 19 but referral bias cannot be excluded.…”

Section: Incidence Of Severe Uc In Childrenmentioning

confidence: 99%

Acute severe ulcerative colitis in children: A systematic review

Turner

Griffiths

2011

Inflammatory Bowel Diseases

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Pediatric ulcerative colitis (UC) has a more severe phenotype, reflected by more extensive disease and a higher rate of acute severe exacerbations. The pooled steroid-failure rate among 291 children from five studies is 34% (95% confidence interval [CI]: 27%-41%). It is suggested that corticosteroids should be dosed between 1-1.5 mg/kg up to 40-60 mg daily. Food restriction has a limited role in severe UC and should be generally discouraged in children who do not have a surgical abdomen. Appraisal of radiologic findings in children must recognize the variation in colonic width with age and size. Data suggest that the Pediatric UC Activity Index (PUCAI), determined at day 3, should be used to screen for patients likely to fail corticosteroids (>45 points), and at day 5 to dictate the introduction of second-line therapy (>65-70 points). Cyclosporine is successful in children with severe colitis but its use should be restricted to 3-4 months while bridging to thiopurine treatment (pooled short-term success rate 81% [95% CI: 76%-86%]; n = 94 from eight studies). Infliximab may be as effective as cyclosporine (75% pooled short-term response (95% CI: 67%-83%); n = 126, six studies) with a pooled 1-year response of 64% (95% CI: 56%-72%). In toxic megacolon, in patients refractory to one salvage medical therapy, and in chronic severe disease, colectomy may be preferred. Decision-making regarding colectomy in children must consider the toxicity of medication consumed over many future years, the quality of life and self-image associated with either choice, as well as both functional outcomes and, in females, fertility following pouch procedures.

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Medical treatment of severe ulcerative colitis

Cited by 48 publications

References 35 publications

Severe paediatric ulcerative colitis: incidence, outcomes and optimal timing for second-line therapy

Severe paediatric ulcerative colitis: incidence, outcomes and optimal timing for second-line therapy

The Asia‐Pacific consensus on ulcerative colitis

Acute severe ulcerative colitis in children: A systematic review

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