CHU de Bordeaux,
service d’hépato-gastroentérologie et nutrition,
France, Inserm U853,
laboratoire de bactériologie,
Intravenous steroids remain the mainstay of conventional therapy for acute severe ulcerative colitis. However, their efficacy is still limited to 67%. A colonic superinfection by CMV or
Clostridium difficile should be rule out before starting second line therapy. To avoid urgent colectomy two medical options are available at this step: cyclosporine and infliximab. The first comparing trial – so called CYSIF – has been conducted by the GETAID and recently achieved. The CYSIF study could not demonstrate that cyclosporine was more effective than infliximab in patients with acute severe ulcerative colitis refractory to intravenous steroids. The benefit of a third line of medical therapy is probably limited when compared to safety. Therefore, colectomy should be considered at this time.