severe ulcerative colitis
Post on 02-Jul-2015
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Severe Ulcerative Colitis
United European of Gastroenterology
Ahmed Abdul Ghany
Bloody diarrhea ≥ 6 motions/ day
Pulse ≥ 90 bpm
Body temperature ≥ 37.8 C
Hemoglobin ≤ 10.5 g/dl
ESR ≥ 30 mm/hr
Role of Colonoscopy
Full colonoscopy should NOT be made due to risk of perforation instead flexible endoscopy may be indicated to assess severity.
Management
• Hospital admission for IV fluids and electrolyte replacement.
• DVT and pulmonary embolism prophylaxis
• IV antibiotics ONLY in patients with high grade fever, leukocytosis and megacolon.
• Enteral nutrition is preferred (NPO in fulminant colitis)
Initial therapy
• Methylprednisolone 20 mg IV every 8 hrs for 1 week.
• High dose oral 5-ASA (Pentaza 4.8 gm daily)
• 5-ASA / steroids enemas and suppository
Maintenance therapy
• Patients who respond to IV glucocorticoids should be converted to equivalent dose of oral steroids
• Oral steroids tapered after 2- 4 weeks
• Rectal 5- ASA / Steroids can be tapered over 2 – 4 months
• Oral 5- ASA should be continued at the same dose.
If he patient did not achieve remission (≤ 3motions a day) by day 3 consider using second line therapy: Azathioprine or Infliximab.
COLECTOMY
• For patients having 4- 8 motions with blood and CRP ≥ 45 mg/L or motions ≥ 8 without blood, the likelihood for later colectomy during the same admission was 85%.
• Total colectomy with ileostomy with preservation of the rectum is advised for a later restorative procedure.
SURVEILLANCE
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