Concord Hospital, Sydney, NSW, Australia.
Royal Adelaide Hospital, Adelaide, SA, Australia.
Aliment Pharmacol Ther. 2016 Jul;44(2):127-44. doi: 10.1111/apt.13670. Epub 2016 May 26.
Acute severe ulcerative colitis (ASUC) is a potentially life-threatening complication of ulcerative colitis.
To develop consensus statements based on a systematic review of the literature of the management of ASUC to improve patient outcome.
Following a literature review, the Delphi method was used to develop the consensus statements. A steering committee, based in Australia, generated the statements of interest. Three rounds of anonymous voting were carried out to achieve the final results. Acceptance of statements was pre-determined by ≥80% votes in 'complete agreement' or 'agreement with minor reservation'.
Key recommendations include that patients with ASUC should be: hospitalised, undergo unprepared flexible sigmoidoscopy to assess severity and to exclude cytomegalovirus colitis, and be provided with venous thromboembolism prophylaxis and intravenous hydrocortisone 100 mg three or four times daily with close monitoring by a multidisciplinary team. Rescue therapy such as infliximab or ciclosporin should be started if insufficient response by day 3, and colectomy considered if no response to 7 days of rescue therapy or earlier if deterioration. With such an approach, it is expected that colectomy rate during admission will be below 30% and mortality less than 1% in specialist centres.
These evidenced-based consensus statements on acute severe ulcerative colitis, developed by a multidisciplinary group, provide up-to-date best practice recommendations that improve and harmonise management as well as provide auditable quality assessments.
急性重度溃疡性结肠炎（ASUC）是溃疡性结肠炎的一种潜在危及生命的并发症。
根据对 ASUC 管理的文献系统评价，制定共识声明，以改善患者的预后。
在文献回顾后，采用 Delphi 法制定共识声明。一个位于澳大利亚的指导委员会提出了感兴趣的声明。进行了三轮匿名投票，以得出最终结果。接受声明的标准是“完全同意”或“有保留地同意”的投票率≥80%。
主要建议包括，ASUC 患者应：住院、接受未准备好的乙状结肠镜检查以评估严重程度并排除巨细胞病毒性结肠炎、接受静脉血栓栓塞预防和静脉注射氢化可的松 100mg，每日 3 或 4 次，并由多学科团队进行密切监测。如果第 3 天没有充分反应，应开始使用英夫利昔单抗或环孢素进行抢救治疗，如果 7 天的抢救治疗无反应或更早出现恶化，则应考虑结肠切除术。采用这种方法，预计在专科中心住院期间的结肠切除术率将低于 30%，死亡率低于 1%。
由多学科小组制定的这些基于证据的急性重度溃疡性结肠炎共识声明，提供了最新的最佳实践建议，可改善和协调管理，并提供可审核的质量评估。
