Ong Ming San Elaine, Sharif Kassem, Rosiou Konstantina, Rennie Michael, Selinger Christian Philipp
Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, St James University Hospital, Bexley Wing, Beckett Street, Leeds LS9 7TF, UK.
Department of Gastroenterology, Sheba Medical Centre, Ramat Gan 5262000, Israel.
J Clin Med. 2024 Dec 6;13(23):7446. doi: 10.3390/jcm13237446.
Acute severe ulcerative colitis is a medical emergency requiring inpatient treatment with intravenous steroids. Approximately one-third of patients do not respond to steroids sufficiently and require medical rescue therapy. Infliximab and cyclosporine are equally effective rescue agents, though infliximab is often preferred by clinicians for ease of use and greater familiarity. The use of cyclosporine is becoming more frequent, however, in patients previously exposed to infliximab. Those patients not exhibiting an adequate response to rescue therapy require colectomy. There is increasing interest in modified medical treatment to rescue the need for surgery. Janus kinase inhibitors may provide benefits when used alongside steroids from admission or as a rescue agent, but further randomised trials are needed to clearly establish their role. Intensified dosing of infliximab when used as a rescue therapy has shown mixed results but seems sensible in patients with low albumin and high disease burden. In this review, we describe the current established treatment pathways and report newer developments and evolving concepts that may in the future improve the care of patients with acute severe ulcerative colitis.
急性重症溃疡性结肠炎是一种需要住院接受静脉注射类固醇治疗的医疗急症。约三分之一的患者对类固醇反应不佳，需要进行药物抢救治疗。英夫利昔单抗和环孢素是同样有效的抢救药物，不过临床医生通常更倾向于使用英夫利昔单抗，因为其使用方便且更为熟悉。然而，在既往使用过英夫利昔单抗的患者中，环孢素的使用越来越频繁。那些对抢救治疗反应不佳的患者需要进行结肠切除术。对于改进药物治疗以避免手术需求的兴趣日益增加。从入院时起或作为抢救药物与类固醇联合使用时， Janus激酶抑制剂可能会带来益处，但需要进一步的随机试验来明确其作用。英夫利昔单抗用作抢救治疗时增加剂量的效果不一，但对于白蛋白水平低且疾病负担重的患者似乎是合理的。在本综述中，我们描述了当前既定的治疗途径，并报告了可能在未来改善急性重症溃疡性结肠炎患者护理的新进展和不断演变的概念。
