Document Detail


Management of acute severe ulcerative colitis.
MedLine Citation:
PMID:  21030524     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Acute severe ulcerative colitis is a potentially lethal condition that requires a pro-active approach with either effective medical treatment or timely colectomy. Although intravenous corticosteroids remain the first line treatment, in patients not responding after 3-5 days rescue medical therapy with either intravenous (IV) cyclosporine 2 mg/kg or infliximab 5 mg/kg IV should be considered. Controlled evidence supports the use of both treatments but medical rescue therapy should not defer the decision for colectomy in patients with inadequate response. Providing clear guidance for the choice between both agents is impossible due to the lack of comparative trials. The better short-term safety profile and the option for maintenance treatment favour infliximab specifically in patients already exposed to immunosuppressives. The rapid onset of action and the short half-life are advantages of cyclosporine in patients with imminent risk of colectomy. Even if cyclosporine and probably also infliximab only postpone colectomy in at least half of the patients, elective colectomy in a later stage of the disease may offer better outcomes. Whereas prolonged exposure to steroids predisposes to an increased rate of peri-operative complications it is still debated whether cyclosporine or infliximab increase peri-operative morbidity in ulcerative colitis.
Authors:
Gert Van Assche; Séverine Vermeire; Paul Rutgeerts
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Publication Detail:
Type:  Journal Article; Review     Date:  2010-10-28
Journal Detail:
Title:  Gut     Volume:  60     ISSN:  1468-3288     ISO Abbreviation:  Gut     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-14     Completed Date:  2011-01-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  2985108R     Medline TA:  Gut     Country:  England    
Other Details:
Languages:  eng     Pagination:  130-3     Citation Subset:  AIM; IM    
Affiliation:
Division of Gastroenterology, Leuven University Hospitals, Leuven, Belgium. gert.vanassche@uz.kuleuven.ac.be
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Antibodies, Monoclonal / therapeutic use
Colectomy
Colitis, Ulcerative / drug therapy*,  surgery
Cyclosporine / therapeutic use
Gastrointestinal Agents / therapeutic use
Humans
Immunosuppressive Agents / therapeutic use
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Gastrointestinal Agents; 0/Immunosuppressive Agents; 0/infliximab; 59865-13-3/Cyclosporine
Comments/Corrections
Comment In:
Gut. 2011 Jan;60(1):3-9   [PMID:  21148578 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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