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Fulminant ulcerative colitis

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Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Opinion statement

  • Fulminant ulcerative colitis necessitates immediate hospitalization.

  • Supportive therapy such as aggressive rehydration, restriction of oral intake, and consideration of parenteral nutrition should be initiated.

  • High-dose intravenous steroids should be started in almost all cases.

  • Antibiotics and cyclosporine should be considered, especially in disease refractory to steroid therapy.

  • Indications for surgery should always be kept in mind, and early involvement of the surgical team is always encouraged.

  • Avoidance of life-threatening complications such as toxic megacolon, hemorrhage, and perforation is the goal of any treatment for fulminant ulcerative colitis.

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References and Recommended Reading

  1. Truelove SC, Witts LJ: Cortisone in ulcerative colitis: final report on a therapeutic trial. BMJ 1955, 2:1041–1048.

    Article  PubMed  CAS  Google Scholar 

  2. Swan NC, Geoghegan JG, O’Donoghue DP, et al.: Fulminant colitis in inflammatory bowel disease: detailed pathologic and clinical analysis. Dis Colon Rectum 1998, 41:1511–1515. A good corellation of clinical and pathological findings in fulminant UC.

    Article  PubMed  CAS  Google Scholar 

  3. Boyko EJ, Koepsell TD, Perera DR, Inui TS: Risk of ulcerative colitis among former and current cigarette smokers. N Engl J Med 1987, 316:707–710.

    Article  PubMed  CAS  Google Scholar 

  4. Dickinson RJ, Ashton MG, Axon AT, et al.: Controlled trial of intravenous hyperalimentation and total bowel rest as an adjunct to the routine therapy of acute colitis. Gastroenterology 1980, 79:1199–1204.

    PubMed  CAS  Google Scholar 

  5. McIntyre PB, Powell-Tuck J, Wood SR, et al.: Controlled trial of bowel rest in the treatment of severe acute colitis. Gut 1986, 27:481–485.

    PubMed  CAS  Google Scholar 

  6. Kornbluth A, Sachar DB: Ulcerative colitis practice guidelines in adults. American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol 1997, 92:204–211. A current guideline to practice.

    PubMed  CAS  Google Scholar 

  7. Rosenberg W, Ireland A, Jewell DP: High-dose methylprednisolone in the treatment of active ulcerative colitis. J Clin Gastroenterol 1990, 12:40–41.

    Article  PubMed  CAS  Google Scholar 

  8. Meyers S, Lerer PK, Feuer EJ, et al.: Predicting the outcome of corticoid therapy for acute ulcerative colitis. Results of a prospective, randomized, doubleblind clinical trial. J Clin Gastroenterol 1987, 9:50–54.

    Article  PubMed  CAS  Google Scholar 

  9. Meyers S, Sachar DB, Goldberg JD, Janowitz HD: Corticotropin versus hydrocortisone in the intravenous treatment of ulcerative colitis. A prospective, randomized, double-blind clinical trial. Gastroenterology 1983, 85:351–357.

    PubMed  CAS  Google Scholar 

  10. Kaplan HP, Portnoy B, Binder HJ, et al.: A controlled evaluation of intravenous adrenocorticotropic hormone and hydrocortisone in the treatment of acute colitis. Gastroenterology 1975, 69:91–95.

    PubMed  CAS  Google Scholar 

  11. Kornbluth A, Marion JF, Salomon P, Janowitz HD: 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 

  12. Jarnerot G, Rolny P, Sandberg-Gertzen H: Intensive intravenous treatment of ulcerative colitis. Gastroenterology 1985, 89:1005–1013.

    PubMed  CAS  Google Scholar 

  13. Travis SP, Farrant JM, Ricketts C, et al.: Predicting outcome in severe ulcerative colitis. Gut 1996, 38:905–910.

    PubMed  CAS  Google Scholar 

  14. Gitnick G: Antibiotics and inflammatory bowel diseases. Gastroenterol Clin North Am 1989, 18:51–56.

    PubMed  CAS  Google Scholar 

  15. Kaufman HS, Kahn AC, Iacobuzio-Donahue C, et al.: Cytomegaloviral enterocolitis: clinical associations and outcome. Dis Colon Rectum 1999, 42:24–30. A disease to think about in the differential diagnosis of fulminant UC.

    Article  PubMed  CAS  Google Scholar 

  16. Loftus EV Jr, Alexander GL, Carpenter HA: Cytomegalovirus as an exacerbating factor in ulcerative colitis. J Clin Gastroenterol 1994, 19:306–309.

    Article  PubMed  Google Scholar 

  17. Chiba M, Fukushima T, Koganei K, et al.: Listeria monocytogenes in the colon in a case of fulminant ulcerative colitis. Scand J Gastroenterol 1998, 33:778–782.

    Article  PubMed  CAS  Google Scholar 

  18. Gilat T, Leichtman G, Delpre G, et al.: A comparison of metronidazole and sulfasalazine in the maintenance of remission in patients with ulcerative colitis. J Clin Gastroenterol 1989, 11:392–395.

    Article  PubMed  CAS  Google Scholar 

  19. Mantzaris GJ, Hatzis A, Kontogiannis P, Triadaphyllou G: Intravenous tobramycin and metronidazole as an adjunct to corticosteroids in acute, severe ulcerative colitis. Am J Gastroenterol 1994, 89:43–46.

    PubMed  CAS  Google Scholar 

  20. Chapman RW, Selby WS, Jewell DP: Controlled trial of intravenous metronidazole as an adjunct to corticosteroids in severe ulcerative colitis. Gut 1986, 27:1210–1212.

    PubMed  CAS  Google Scholar 

  21. Marion JF, Present DH: The modern medical management of acute, severe ulcerative colitis. Eur J Gastroenterol Hepatol 1997, 9:831–835.

    PubMed  CAS  Google Scholar 

  22. Hanauer SB: Review articles: Drug therapy: Inflammatory Bowel Disease. N Engl J Med 1996, 334:841–848. A good review.

    Article  PubMed  CAS  Google Scholar 

  23. Sandborn WJ: Pouchitis following ileal pouch-anal anastomosis: definition, pathogenesis, and treatment [comments]. Gastroenterology 1994, 107:1856–1860.

    PubMed  CAS  Google Scholar 

  24. Hurst RD, Molinari M, Chung TP, et al.: Prospective study of the incidence, timing and treatment of pouchitis in 104 consecutive patients after restorative proctocolectomy. Arch Surg 1996, 131:497–502.

    PubMed  CAS  Google Scholar 

  25. Madden MV, McIntyre AS, Nicholls RJ: Double-blind crossover trial of metronidazole versus placebo in chronic unremitting pouchitis. Dig Dis Sci 1994, 39:1193–1196.

    Article  PubMed  CAS  Google Scholar 

  26. Mantzaris GJ, Archavlis E, Christoforidis P, et al.: A prospective randomized controlled trial of oral ciprofloxacin in acute ulcerative colitis. Am J Gastroenterol 1997, 92:454–456.

    PubMed  CAS  Google Scholar 

  27. Turunen UM, Farkkila MA, Hakala K, et al.: Long-term treatment of ulcerative colitis with ciprofloxacin: a prospective, double-blind, placebo-controlled study [comments]. Gastroenterology 1998, 115:1072–1078.

    Article  PubMed  CAS  Google Scholar 

  28. Lee DK, Cooper BT, Barbezat GO: Clostridium difficile toxin in chronic idiopathic colitis. N Z Med J 1986, 99:620–622.

    PubMed  CAS  Google Scholar 

  29. Trnka YM, Lamont JT: Clostridium difficile colitis. Adv Intern Med 1984, 29:85–107.

    PubMed  CAS  Google Scholar 

  30. Dickinson RJ, O’Connor HJ, Pinder I, et al.: Double blind controlled trial of oral vancomycin as adjunctive treatment in acute exacerbations of idiopathic colitis. Gut 1985, 26:1380–1384.

    PubMed  CAS  Google Scholar 

  31. Burke DA, Axon AT, Clayden SA, et al.: The efficacy of tobramycin in the treatment of ulcerative colitis. Aliment Pharmacol Ther 1990, 4:123–129.

    Article  PubMed  CAS  Google Scholar 

  32. Lobo AJ, Burke DA, Sobala GM, Axon AT: Oral tobramycin in ulcerative colitis: effect on maintenance of remission. Aliment Pharmacol Ther 1993, 7:155–158.

    Article  PubMed  CAS  Google Scholar 

  33. Lichtiger S, Present DH: Preliminary report: cyclosporin in treatment of severe active ulcerative colitis [comments]. Lancet 1990, 336:16–19.

    Article  PubMed  CAS  Google Scholar 

  34. Lichtiger S, Present DH, Kornbluth A, et al. Cyclosporine in severe ulcerative colitis refractory to steroid therapy [comments]. N Engl J Med 1994, 330:1841–1845.

    Article  PubMed  CAS  Google Scholar 

  35. Stack WA, Long RG, Hawkey CJ: 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 

  36. Hyde GM, Thillainayagam AV, Jewell DP: Intravenous cyclosporin as rescue therapy in severe ulcerative colitis: time for a reappraisal? Eur J Gastroenterol Hepatol 1998, 10:411–413.

    Article  PubMed  CAS  Google Scholar 

  37. Actis GC, Aimo G, Priolo G, et al.: Efficacy and efficiency of oral microemulsion cyclosporin versus intravenous and soft gelatin capsule cyclosporin in the treatment of severe steroid-refractory ulcerative colitis: an open-label retrospective trial. Inflamm Bowel Dis 1998, 4:276–279.

    Article  PubMed  CAS  Google Scholar 

  38. Treem WR, Cohen J, Davis PM, et al.: Cyclosporine for the treatment of fulminant ulcerative colitis in children. Immediate response, long-term results, and impact on surgery. Dis Colon Rectum 1995, 38:474–479.

    Article  PubMed  CAS  Google Scholar 

  39. Andreoli A, Falasco G, Mangiarotti R, Prantera C: Efficacy of long-term oral 6-mercaptopurine therapy in maintaining remission induced by intravenous cyclosporine in steroid-refractory sever ulcerative colitis. Gastroenterology 1999, 116:C2886.

    Google Scholar 

  40. Geert D, Lemmens L, Hiele M, et al.: Remission of severe ulcerative colitis with cyclosporine monotherapy is effectively maintained with further immunosuppression. Gastroenterology 1999, 116:G3134.

    Google Scholar 

  41. Cohen RD, Stein R, Hanauer SB: Intravenous cyclosporin in ulcerative colitis: a five-year experience. Am J Gastroenterology 1999, 94:1587–1592.

    Article  CAS  Google Scholar 

  42. Stack WA, Williams D, Stevenson M, Logan RF: Immunosuppressive therapy for ulcerative colitis: results of a nation-wide survey among consultant physician members of the British Society of Gastroenterology. Aliment Pharmacol Ther 1999, 13:569–575.

    Article  PubMed  CAS  Google Scholar 

  43. Becker JM: Surgical therapy for ulcerative colitis and Crohn’s disease. Gastroenterol Clin North Am 1999, 28:371–390.

    Article  PubMed  CAS  Google Scholar 

  44. Zenilman ME, Becker JM: Emergencies in inflammatory bowel disease. Gastroenterol Clin North Am 1988, 17:387–408.

    PubMed  CAS  Google Scholar 

  45. Grant CS, Dozois RR: Toxic megacolon: ultimate fate of patients after successful medical management. Am J Surg 1984, 147:106–110.

    Article  PubMed  CAS  Google Scholar 

  46. Binderow SR, Wexner SD: Current surgical therapy for mucosal ulcerative colitis. Dis Colon Rectum 1994, 37:610–624.

    Article  PubMed  CAS  Google Scholar 

  47. Smith LE: Surgical therapy in ulcerative colitis. Gastroenterol Clin North Am 1989, 18:99–110.

    PubMed  CAS  Google Scholar 

  48. Ritchie JK: Ulcerative colitis treated by ileostomy and excisional surgery. Fifteen years’ experience at St. Mark’s Hospital. Br J Surg 1972, 59:345–351.

    Article  PubMed  CAS  Google Scholar 

  49. Sawada K, Ohnishi K, Kosaka T, et al.: Leukocytapheresis with leukocyte removal filter as new therapy for ulcerative colitis. Ther Apher 1997, 1:207–211.

    PubMed  CAS  Google Scholar 

  50. Sasaki M, Tsujikawa T, Fujiyama Y, Bamba T: Leukocytapheresis therapy for severe ulcerative colitis. Ther Apher 1998, 2:101–104.

    PubMed  CAS  Google Scholar 

  51. Sawada K, Ohnishi K, Egashira A, et al.: Prospective multicenter randomized study of leukocytapheresis using filter method for ulcerative colitis. Gastroenterology 1999, 116:G3526.

    Google Scholar 

  52. Nagase K, Sawada K, Ohnishi K, et al.: Complications of leukocytapheresis. Ther Apher 1998, 2:120–124.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. 2E3.11, Walter MacKenzie Health Sciences Centre, 8440 112th St., T6G 2B7, Edmonton, Alberta, Canada

    B. R. Yacyshyn MD, FRCPC

  2. Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada

    Clarence K. W. Wong MD, FRCPC

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  1. Clarence K. W. Wong MD, FRCPC
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  2. B. R. Yacyshyn MD, FRCPC
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Wong, C.K.W., Yacyshyn, B.R. Fulminant ulcerative colitis. Curr Treat Options Gastro 3, 217–226 (2000). https://doi.org/10.1007/s11938-000-0025-8

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  • DOI: https://doi.org/10.1007/s11938-000-0025-8

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