ABSTRACT
Acute severe ulcerative colitis (ASUC) is one emergency in pediatric gastroenterology.The disease is serious, which may even endanger the life of patients.Close monitoring and timely pharmacological and surgical interventions are key measures to improve outcomes.Treatment methods for ASUC include necessary nutritional support, water and electrolyte disturbance correction, and possible concurrent bacterial or viral infection elimination.Patients at high risk require subcutaneous injections of low molecular weight heparin to prevent thrombosis.Intravenous cortico-steroids are the first-line treatment of ASUC.For patients showing insufficient response to corticosteroids after 3-5 days, rescue treatment with immunosuppressants or biological agents is needed.Meanwhile, the clinical symptoms, serum inflammatory indicators and albumin levels of the patients should be closely monitored.Patients who failed medical treatment should undergo timely colectomy to prevent serious complications.In this paper, a systematic review of literature and expert consensus was conducted to summarize the clinical evaluation and treatment methods of ASUC children at different stages, in order to standardize the clinical treatment of pediatric ASUC.
ABSTRACT
Acute severe ulcerative colitis (ASUC) is a medical emergency that requires prompt diagnosis and treatment. Intravenous corticosteroids are the first-line medical therapy, yet over 30% of the patients are steroid-refractory. The response to steroids should be assessed on day 3 after treatment initiation; in non-responders, treatment options including ciclosporin and infliximab, or surgery should be considered. Both ciclosporin and infliximab are effective and safe salvage therapy. Colectomy is recommended if there is no improvement following 4 to 7 days of salvage therapy. Total proctocolectomy and ileal pouch-anal anastomosis is the standard surgical procedure. A three-step approach is advocated and the postoperative complications should be cared. The diagnosis and treatment of ASUC requires multidisciplinary cooperation in order to improve prognosis and reduce mortality.
ABSTRACT
Acute severe ulcerative colitis (ASUC) is a potentially life-threatening condition.Inappropriate salvage therapy might delay the surgery and increase the mortality and postoperative complications in ulcerative colitis (UC).Timely surgical intervention for UC is the key to reduce the rate of mortality and postoperative complications via evaluating the effect of therapy combining with characters of patients' history,clinical symptoms,biochemical markers,radiological and endoscopic criteria.
ABSTRACT
Background:Of patients with acute severe ulcerative colitis (ASUC),30% -40% is steroid-refractory and required second-line medical therapy or colectomy. Infliximab (IFX)may be effective as rescue therapy. Aims:To explore preliminarily the efficacy and safety of IFX as rescue therapy in ASUC in China. Methods:A retrospective study was conducted in 10 consecutive ASUC patients receiving IFX as rescue therapy from June 2012 to September 2016 at Peking Union Medical College Hospital. The modified Mayo score and laboratory parameters were compared at baseline and on week 2,week 12 and week 30 of the treatment course. Results:The response rates on week 2,week 12 and week 30 of IFX treatment were 90. 0% (9/ 10),90. 0% (9/ 10)and 71. 4% (5/ 7),respectively,and the remission rates were 20. 0% (2/10),30. 0% (3/ 10)and 28. 6% (2/ 7),respectively. One patient was primary non-responder to IFX,and two lost response on week 30 (secondary non-response). Seven patients were followed up for 38 weeks. Two patients underwent colectomy. After (9. 6 ± 7. 0)months on average,endoscopic improvement occurred in 50. 0% (5/ 10)of patients,of which one achieved mucosal healing. During treatment course,one case of herpes zoster virus infection and one case of cytomegalovirus infection were recorded. Conclusions:This retrospective study revealed good short-term response to IFX treatment in patients with ASUC in China. It may reduce colectomy rate and promote mucosal healing. However,the rate of secondary loss of response is relatively high. During treatment course,viral infection should be monitored.
ABSTRACT
Background:Of patients with acute severe ulcerative colitis (ASUC),30% -40% is steroid-refractory and required second-line medical therapy or colectomy. Infliximab (IFX)may be effective as rescue therapy. Aims:To explore preliminarily the efficacy and safety of IFX as rescue therapy in ASUC in China. Methods:A retrospective study was conducted in 10 consecutive ASUC patients receiving IFX as rescue therapy from June 2012 to September 2016 at Peking Union Medical College Hospital. The modified Mayo score and laboratory parameters were compared at baseline and on week 2,week 12 and week 30 of the treatment course. Results:The response rates on week 2,week 12 and week 30 of IFX treatment were 90. 0% (9/ 10),90. 0% (9/ 10)and 71. 4% (5/ 7),respectively,and the remission rates were 20. 0% (2/10),30. 0% (3/ 10)and 28. 6% (2/ 7),respectively. One patient was primary non-responder to IFX,and two lost response on week 30 (secondary non-response). Seven patients were followed up for 38 weeks. Two patients underwent colectomy. After (9. 6 ± 7. 0)months on average,endoscopic improvement occurred in 50. 0% (5/ 10)of patients,of which one achieved mucosal healing. During treatment course,one case of herpes zoster virus infection and one case of cytomegalovirus infection were recorded. Conclusions:This retrospective study revealed good short-term response to IFX treatment in patients with ASUC in China. It may reduce colectomy rate and promote mucosal healing. However,the rate of secondary loss of response is relatively high. During treatment course,viral infection should be monitored.
ABSTRACT
La colitis ulcerativa aguda severa es una urgencia médica que puede comprometer la vida del paciente; requiere una alta sospecha diagnóstica para establecer un manejo adecuado y oportuno, y prevenir complicaciones. Es necesario determinar factores pronósticos para identificar pacientes de alto riesgo. Los esteroides intravenosos son tratamiento de primera línea, en caso de no respuesta, el uso de terapia de "rescate" con infliximab o ciclosporina reduce el riesgo de colectomía a corto plazo, sin comprometer la seguridad del paciente.
Acute severe ulcerative colitis is a potentially life-threatening condition that requires a pro-active approach with either effective medical treatment or timely colectomy. It is very important to identify at an early stage those who are likely to fail intensive treatment. Although intravenous steroids remain the first line, for those who fail, currently available 'rescue' medical therapy with infliximab and cyclosporine may reduce the risk of colectomy in the short term without compromising safety.