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Traitement médical des colites inflammatoires aiguës graves

The medical treatment of acute, serious attacks of inflammatory colitis

  • Published:
Acta Endoscopica

Résumé

Les colites aiguës sévères compliquent aussi bien la colite ulcéreuse que la maladie de Crohn. Il s’agit d’une complication grave qui en l’absence d’une prise en charge correcte, médico-chirurgicale en milieu spécialisé, risque de mettre en jeu le pronostic vital. L’étape diagnostique est importante pour éviter les erreurs thérapeutiques. Les critères de gravité reposent sur des critères clinico-biologiques et morphologiques. L’évaluation de la gravité permet de dépister une complication (perforation, colectasie, hémorragie) nécessitant une chirurgie d'urgence. En l'absence de complication, le traitement médical repose sur la corticothérapie par voie veineuse, la mise au repos du tube digestif et une réanimation hydro-électrolytique. L'absence d'amélioration ou l'aggravation évaluée sur une période de 5 à 7 jours fait actuellement proposer un traitement par ciclosporine par voie ve ineuse. Si la ciclosporine ne peut être utilisée ou si elle est inefficace, une colectomie d’urgence doit être réalisée. Celle-ci est indiquée à toutes lesétapes du traitement si la situation s’aggrave.

Summary

Acute severe colitis can complicate both ulcerative colitis and Crohn’s disease. It is a serious complication that in the absence of correct medical and possible surgical treatment in a specialised centre risks jeopardising chances of survival. The diagnostic stage is important in order to avoid errors in treatment. The seriousness of the condition is assessed in terms of clinical-biological and morphological criteria. Evaluating the gravity of the attack correctly can avoid a complication (perforation, toxix megacolon, haemorrhage) that would require emergency surgery. In the absence of complications, medical treatment requires intravenous corticosteroid therapy, a period of respite for the digestive tract and intensive control of the electrolytic balance. The absence of improvement or signs of worsening within a period of 5 to 7 days calls for the addition of intravenous cyclosporin. If cyclosporin cannot be used or if it is ineffective an emergency colectomy has to be performed. This is indicated at any stage of treatment if the situation deteriorates.

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Références

  1. JEWELL D., CAPRILLI R., MORTENSEN N., NICHOLLS R.J., WRIGHT J.D. — Indication and timing of surgery for severe ulcerative colitis.Gastroenterol. Intern., 1991,4, 161–164.

    Google Scholar 

  2. SCHUMACHER G., KOLBERG B., SANDSTEDT B. — A prospective study of first attacks of inflammatory bowel disease and infectious colitis: Histologic course during the first year after presentation.Scand. J. Gastroenterol., 1994,29, 318–332.

    Article  PubMed  CAS  Google Scholar 

  3. GAST P., BELAICHE J. — Rectal endosonography in inflammatory bowel disease: differential dignosis and prediction of remission.Endoscopy, 1999,31, 158–167.

    Article  PubMed  CAS  Google Scholar 

  4. BELAICHE J., LOUIS E., D’HAENS G., CABOOTER M., NAEGELS S., DE VOS M., FONTAINE F., SCHURMANS P., BAERT F., DE REUCK M., FIASSE R., HOLVOET J., SCHMIT A., VAN OUTRYVE M., and the Belgian IBD research group. — Acute lower gastrointestinal bleeding in Crohn’s disease: characteristics of a unique series of 34 patients.Am. J. Med., 1999,94, 2177–2181.

    CAS  Google Scholar 

  5. PRESENT D.H., WOLFSON D., GELERNT I.M., RUBBIN P.H., BAUER J., CHAPMAN M.L. — Medical decompression of toxic megacolon by «rolling». A new technique of decompression with favorable long term follow-up.J. Clin. Gastroenterol., 1988,10, 485–490.

    Article  PubMed  CAS  Google Scholar 

  6. WALMSLEY R.S., AYRES R.C.S., POUNDER R.E., ALLAN R.N. — A simple clinical colitis activity index.Gut, 1998,43, 29–32.

    PubMed  CAS  Google Scholar 

  7. ALEMAYEHU G., JARNEROT G. — Colonoscopy during an attack of severe ulcerative colitis is a safe procedure and of great value in clinical decision making.Am. J. Gastroenterol., 1991,86, 187–190.

    PubMed  CAS  Google Scholar 

  8. CARBONNEL F., LAVERGNE A., LEMANN M., BITOUN A., VALLEUR P., HAUTEFEUILLE P., GALIAN A., MODIGLIANI R., RAMBAUD J.C. — Colonoscopy of acute colitis. A safe and reliable tool for the assessment of severity.Dig. Dis. Sci., 1994,39, 1550–1557.

    Article  PubMed  CAS  Google Scholar 

  9. KORNBLUTH A.A., MARION J.F., SALOMON P., JANOWITZ H.D. — How effective is current medical therapy for severe ulcerative and Crohn’s colitis? An analytic review of selected trials.J. Clin. Gastroenterol., 1995,20, 280–284.

    Article  PubMed  CAS  Google Scholar 

  10. LICHTIGER S., PRESENT D.H., KOMBLUTH A., GELERNT I., BAUER G., GALLER G., MICHELASSI F., HANAUER S. — Cyclosporine in severe ulcerative colitis refractory to steroid therapy.N. Engl. J. Med., 1994,330, 1841–1845.

    Article  PubMed  CAS  Google Scholar 

  11. SANDBORN W.J. — A critical review of cyclosporine therapy in inflammatory bowel disease.Inflam. Bowel Dis., 1995,1, 48–63.

    Article  Google Scholar 

  12. CARBONNEL F., BORUCHOWICZ A., DUCLOS B., SOULÉ J.C., LEREBOURS E., LEMANN M., BELAICHE J., COLOMBEL J.F., COSNES J., GENDRE J.P. — Intravenous cyclosporine in attacks of ulcerative colitis. Shortterm and long-term responses.Dig. Dis. Sci., 1996,41, 2471–2476.

    Article  PubMed  CAS  Google Scholar 

  13. VAN GOSSUM A., SCHMIT A., ADLER M., CHIOCCIOLI C., FIASSE R., LOUWAGIE P., D’HAENS G., RUTGEERTS P., DE VOS M., REYNAERT H., DEVIS G., BELAICHE J., VAN OUTRYVE M. — Short- and long-term efficacy of cyclosporin administration in patients with acute severe ulcerative colitis.Acta gastroenterol. bel., 1997,60, 197–200.

    Google Scholar 

  14. STACK W.A., LONG R.G., HAWKEY C.J. — Short- and long-term outcome of patients treated with cyclosporin for severe acute ulcerative colitis.Aliment Pharmacol. Ther., 1998,12, 973–978.

    Article  PubMed  CAS  Google Scholar 

  15. HYDE G.M., THILLAINAYAGAM A.V., JEWELL D.P. — Intravenous cyclosporin as rescue therapy in severe ulcerative colitis: time for a reappraisal?Eur. J. Gatroenterol. Hepatol., 1998,10, 411–413.

    Article  CAS  Google Scholar 

  16. ACTIS G.C., ROCCA G., PINNA-PINTOR M., RIZZETTO M. — Azathioprine (AZA) to maintain the response of acute ulcerative colitis (UC) to cyclosporin.Gastroenterology, 1998,114, G3760.

    Article  Google Scholar 

  17. SANTOS J.V., BAUDET J.A., CASELLAS F.J., GAURNER L.A., VILASECA J.M., MALAGELADA J.R. — Intravenous cyclosporine for steroid-refractory attacks of Crohn’s disease. Short- and long-term results.J. Clin. Gastroenterol., 1995,20, 207–210.

    PubMed  CAS  Google Scholar 

  18. LEMANN M., DE LA VALUSSIÈRE F., BOUHNIK Y., ALLEZ M, TOUZE Y, BONNET J, COFFIN B, MATUCHANSHY C, JIAN R, COLOMBEL JF, RAMBAUD JC, MODIGLIANI R. — Intravenous cyclosporine for refractory attacks of Crohn’s disease: a long term follow-up of patients.Gastroenterology, 1998,113, G4178.

    Google Scholar 

  19. LEMANN M., MODIGLIANI R. — In Lemann M., Modigliani R. eds. Maladies inflammatoires de l’intestin. Paris: Doin, 1998, 225–271.

    Google Scholar 

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Authors and Affiliations

  1. Service de gastro-entérologie, CHU Sart-Tilman, 4000, Liege, (Belgique)

    J. Belaiche

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  1. J. Belaiche
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Belaiche, J. Traitement médical des colites inflammatoires aiguës graves. Acta Endosc 29, 569–575 (1999). https://doi.org/10.1007/BF03022169

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