Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, St James University Hospital, Bexley Wing, Leeds, LS9 7TF, UK.
University of Leeds, Leeds, UK.
Intern Emerg Med. 2021 Sep;16(6):1433-1442. doi: 10.1007/s11739-021-02704-0. Epub 2021 Mar 22.
Acute severe ulcerative colitis is a medical emergency that warrants in-patient management. This is best served within a multidisciplinary team setting in specialised centres or with expert consultation. Intravenous corticosteroids remain the cornerstone in the management of ASUC and should be initiated promptly, along with general management measures and close monitoring of patients. Unfortunately, one-third of patients will fail to respond to steroids. Response to intravenous corticosteroid therapy needs to be assessed on the third day and rescue therapies, including cyclosporine and infliximab, should be offered to patients not responding. Choice of rescue therapy depends on experience, drug availability and factors associated with each individual patient, such as comorbidities, previous medications or contra-indications to therapy. Patients who have not responded within 7 days to rescue therapy must be considered for surgery. Surgery is a treatment option in ASUC and should not be delayed in cases of failure of medical therapy, because such delays increase surgical morbidity and mortality. This review summarises the current management of acute severe ulcerative colitis and discusses potential future developments.
急性重度溃疡性结肠炎是一种医疗急症，需要住院治疗。最好在多学科团队的专业中心进行治疗，或者寻求专家咨询。静脉注射皮质类固醇仍然是治疗重度溃疡性结肠炎的基石，应尽快启动，并同时进行一般治疗措施和密切监测患者。不幸的是，三分之一的患者对类固醇治疗无反应。应在第 3 天评估静脉注射皮质类固醇治疗的反应，并为未反应的患者提供环孢素和英夫利昔单抗等抢救治疗。抢救治疗的选择取决于经验、药物可用性以及与每位患者相关的因素，如合并症、先前的药物治疗或治疗的禁忌症。对于在 7 天内未对抢救治疗有反应的患者，必须考虑手术治疗。手术是急性重度溃疡性结肠炎的一种治疗选择，不应因药物治疗失败而延迟手术，因为此类延迟会增加手术发病率和死亡率。本综述总结了急性重度溃疡性结肠炎的当前治疗方法，并讨论了潜在的未来发展。
