|
|
 |
 |
| |
 Printable version |
How optimize the management of a patient with a severe attack of ulcerative colitis? |
Hépato-Gastro. Volume 17, 21-7, Avancées dans la prise en charge des MICI en 2010, mini-revue
|
 Résumé
Texte intégral
|
Author(s) : David Laharie |
Summary : A severe attack of ulcerative colitis (UC) occurs in 10-15% of patients and may begin the disease. The diagnosis is best defined by the usual Truelove and Witts' criteria. At entry, patients must be screened for micro-organisms, mostly Clostridium difficile and cytomegalovirus. Patients should be hospitalised and best cared for jointly by a gastroenterologist and surgeon. Short drug courses are mandatory and colectomy should be considered and discussed at each stage. In 2010, intravenous steroids are the first-line treatment. Steroid-failure is assessed about the fifth day and predicted about the third day. Second-line therapy with either ciclosporin, or infliximab would be considered. The ongoing CYSIF clinical trial comparing these two drugs in severe UC patients refractory to steroids will determine the agent with best efficacy and tolerance. Third-line medical treatment is not recommanded and may be only considered at a specialist centre. |
Keywords : severe ulcerative colitis, steroids, cyclosporine, infliximab, colectomy |
|
