The Management of the Hospitalized Ulcerative Colitis Patient: the Medical–Surgical Conundrum

被引：9
作者：
Carvello M. [1 ]
Watfah J. [2 ]
Włodarczyk M. [3 ]
Spinelli A. [1 ,4 ]
机构：
[1] Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, Rozzano, Milan
[2] Department of General Surgery, Northwick Park Hospital, London
[3] Department of General and Colorectal Surgery, Medical University of Lodz, Haller 1 Sq, Lodz
[4] Department of Biomedical Sciences, Humanitas University, Rozzano, Milan
来源：
Current Gastroenterology Reports | 2020年 / 22卷 / 3期
关键词：
Inpatient; Surgery; Ulcerative colitis; Urgent management;
D O I：
10.1007/s11894-020-0750-1
中图分类号：
学科分类号：
摘要：
Purpose of Review: In this study, we present the evidence-based management for patients hospitalized for ulcerative colitis (UC) with a special focus on the synergic approach of the two key actors of the inflammatory bowel disease multidisciplinary team (IBD-MDT): gastroenterologist and surgeon. Recent Findings: Focused treatment by a specialized IBD-MDT and early involvement of the colorectal surgeon in the management of hospitalized UC patients is advocated. The colectomy rate has not changed over the years. Moreover, delayed surgery after admission is burden by increase complication and mortality rates. Thus, it is pivotal to identify the patients who are likely to undergo surgery, by mean of predictors of outcome, and not to prolong ineffective medical treatment. The perfect timing based on clinical close monitoring is crucial. Summary: Up to 25% of patients with ulcerative colitis (UC) may require hospitalization. The aim of admission is to evaluate severity of the disease, exclude infections and establish proper treatment while monitoring the response. During admission, the patient has to be closely observed for the possible development of toxic megacolon or perforation, which should prompt emergency colectomy. Up to 30% of UC patients will fail to respond to initial intravenous corticosteroid. Non-responder or partial responder to medical therapy should be evaluated for timely surgery or could be considered for rescue medical therapy. © 2020, Springer Science+Business Media, LLC, part of Springer Nature.
引用
收藏
相关论文
共 66 条
  • [1] Magro F., Gionchetti P., Eliakim R., Ardizzone S., Armuzzi A., Barreiro-de Acosta M., Burisch J., Gecse K.B., Hart A.L., Hindryckx P., Langner C., Limdi J.K., Pellino G., Zagorowicz E., Raine T., Harbord M., Rieder F., Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-intestinal Manifestations, Pregnancy, Cancer Surveillance, Surgery, and Ileo-anal Pouch Disorders, Journal of Crohn's and Colitis, 11, 6, pp. 649-670, (
  • [2] Oresland T., Bemelman W.A., Sampietro G.M., Spinelli A., Windsor A., Ferrante M., Marteau P., Zmora O., Kotze P.G., Espin-Basany E., Tiret E., Sica G., Panis Y., Faerden A.E., Biancone L., Angriman I., Serclova Z., de Buck van Overstraeten A., Gionchetti P., Stassen L., Warusavitarne J., Adamina M., Dignass A., Eliakim R., Magro F., D'Hoore A., European evidence based consensus on surgery for ulcerative colitis, Journal of Crohn's and Colitis, 9, 1, pp. 4-25, (2014)
  • [3] Oresland T., Bemelman W.A., Sampietro G.M., Spinelli A., Windsor A., Ferrante M., Marteau P., Zmora O., Kotze P.G., Espin-Basany E., Tiret E., Sica G., Panis Y., Faerden A.E., Biancone L., Angriman I., Serclova Z., de Buck van Overstraeten A., Gionchetti P., Stassen L., Warusavitarne J., Adamina M., Dignass A., Eliakim R., Magro F., D'Hoore A., European evidence based consensus on surgery for ulcerative colitis, J Crohns Colitis, 9, pp. 4-25, (2015)
  • [4] Dinesen L.C., Walsh A.J., Protic M.N., Heap G., Cummings F., Warren B.F., George B., Mortensen N.J.M., Travis S.P.L., The pattern and outcome of acute severe colitis, Journal of Crohn's and Colitis, 4, 4, pp. 431-437, (2010)
  • [5] Aratari A., Papi C., Clemente V., Moretti A., Luchetti R., Koch M., Capurso L., Caprilli R., Colectomy rate in acute severe ulcerative colitis in the infliximab era, Digestive and Liver Disease, 40, 10, pp. 821-826, (2008)
  • [6] Lynch R.W., Lowe D., Protheroe A., Driscoll R., Rhodes J.M., Arnott I.D.R., Outcomes of rescue therapy in acute severe ulcerative colitis: data from the United Kingdom inflammatory bowel disease audit, Alimentary Pharmacology & Therapeutics, 38, 8, pp. 935-945, (2013)
  • [7] Jain S., Kedia S., Sethi T., Bopanna S., Yadav D.P., Goyal S., Padhan R., Venigalla P.M., Sahni P., Dash N.R., Pal S., Makharia G., Travis S.P.L., Ahuja V., Predictors of long-term outcomes in patients with acute severe colitis: A northern Indian cohort study, Journal of Gastroenterology and Hepatology, 33, 3, pp. 615-622, (2018)
  • [8] Farthing M., John Lennard-Jones 1927–2019: physician and gastroenterologist, Gut, 68, 7, pp. 1137-1138, (2019)
  • [9] Morar P.S., Sevdalis N., Warusavitarne J., Hart A., Green J., Edwards C., Faiz O., Establishing the aims, format and function for multidisciplinary team-driven care within an inflammatory bowel disease service: a multicentre qualitative specialist-based consensus study, Frontline Gastroenterology, 9, 1, pp. 29-36, (2017)
  • [10] Calvet X., Panes J., Alfaro N., Hinojosa J., Sicilia B., Gallego M., Perez I., Lazaro y de Mercado P., Gomollon F., Delphi consensus statement: Quality indicators for Inflammatory Bowel Disease Comprehensive Care Units, Journal of Crohn's and Colitis, 8, 3, pp. 240-251, (2014)
1234567