Management of severe acute ulcerative colitis

摘要

Acute severe colitis is a classic complication of inflammatory bowel disease, especially of ulcerative colitis. It is a short-term life-threatening medical and surgical emergency. Acute severe ulcerative colitis diagnosis is based on clinical and biological criteria. The first medical evaluation should identify serious complications that require surgery in emergency and exclude a bowel infection (especially Clostridium Difficile or cytomegalovirus infections).In acute severe colitis, intravenous corticosteroids are the conventionnal medical treatment. However, roughly one third of patients are resistant to the treatment. Ciclosporin and infliximab are potential rescue treatments in this case, with a similar efficacy. Colectomy remains the best option in case of complicated acute severe colitis and should be discussed as an option at each stage of the treatment.