JLE

Hépato-Gastro & Oncologie Digestive

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Unclassified colitis Volume 22, issue 8, Octobre 2015

Figures


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Tables

Author
Hôpital Saint-Antoine,
service de gastro-entérologie et nutrition,
184 rue du faubourg Saint-Antoine,
75571 Paris cedex 12, France ;
UPMC Université Paris 06, GRC n̊03, SUVIMIC,
F-75012, Paris, France
* Tirés à part

Colitis with acute onset is conventionally defined as acute colitis up to one month after symptom onset. Acute colitis is considered as unclassified as long as there is no microbiological proof of infectious (mainly bacterial) colitis, and no unambiguous criteria of inflammatory bowel disease (IBD). The appropriate initial management of patients with acute colitis consists of a microbiological work-up including the search for Clostridium difficile infection, at least a partial colonoscopy with multiple biopsies, and the initiation of a probabilistic antibiotic treatment. In the context of a non-severe colitis, anti-inflammatory drugs are secondarily indicated if histological proof or IBD is obtained and/or if colitis does not rapidly improve under antibiotics. In case of acute severe colitis, the treatment should include anti-inflammatory drugs (usually systemic corticosteroids) together with antibiotics, and should be secondarily adapted to microbiological and histologic features. When colitis remains unclassified after an acute episode, long-term clinical evolution makes it possible to distinguish a posteriori between acute self-limited colitis and first flares of IBD. IBD is conventionally defined as unclassified as long as patients have no specific anatomical lesions of Crohn's disease and do not fulfill all diagnostic criteria for ulcerative colitis. The status of unclassified colitis may be very prolonged (>10 years). During this period, the serological status of perinuclear antineutrophilic cytoplasmic antibodies (pANCA) and anti-Saccharomyces cerevisiae antibodies (ASCA) may suggest the final diagnosis of ulcerative colitis or Crohn's disease in about one half of the patients. The diagnostic uncertainty has fewer and fewer impact on therapeutic decisions, since most of the drugs that are currently used are active on Crohn's disease and ulcerative colitis. In addition, the indication of proctocolectomy is increasingly admitted in patients with Crohn's disease without involvement of the ileum and the perianal area.