Postgraduate Course at DDW: Complete Clinical Updates for Today's Practice | May 2025-BO

BO_Kaur ACUTE SEVERE ULCERATIVE COLITIS

Pdf Summary

Acute severe ulcerative colitis (ASUC) requires hospitalization when there are more than six bowel movements above baseline within 24 hours accompanied by systemic signs of toxicity, such as tachycardia or fever. The initial assessment involves documenting the location, extent, and activity of the disease, considering co-existing conditions, prior treatment responses, and evaluating the inflammatory burden, including nutritional status and anemia.<br /><br />On the first hospital day, important diagnostics include complete blood count, comprehensive metabolic panel, CRP, imaging, and stool studies. Immediate interventions include resuscitation, IV fluids, corticosteroids, VTE prophylaxis, and possibly a surgical consult. It is critical to avoid certain medications, such as anticholinergics and opioids, during this time.<br /><br />Early endoscopy, ideally within 72 hours, helps score disease severity. Patients with deep ulcers or extensive mucosal loss might be at higher risk for colectomy. Co-infections, like C. difficile and CMV, must be treated alongside UC, with IV Ganciclovir recommended for CMV.<br /><br />Corticosteroids are standard for ASUC, with a typical regimen including methylprednisolone 20 mg IV q8h. Monitoring involves daily symptom and lab evaluations to gauge steroid response. Predictors of steroid failure include high bowel movements or CRP levels, prompting the consideration of alternative therapies like Infliximab or cyclosporin by days 3 to 4.<br /><br />Therapies for steroid-refractory ASUC might include JAK inhibitors or surgery, with the choice influenced by the patient's treatment history and condition severity. In cases where surgery becomes necessary, early intervention is associated with lower mortality and morbidity.<br /><br />Overall, key strategic points emphasize early assessment, prompt steroid initiation, simultaneous infection treatment, early surgical consultation, and informed choices for rescue therapies based on prior treatments and disease dynamics.

Keywords

acute severe ulcerative colitis

hospitalization

systemic toxicity

diagnostics

corticosteroids

endoscopy

co-infections

steroid-refractory

JAK inhibitors

surgical intervention