Management of acute severe colitis

Management of acute severe colitis

Statement 6.4

Children and adults admitted as inpatients with acute severe colitis should have daily review by appropriate specialists.

Statement 6.5

For patients with acute severe colitis, stool culture and Clostridium difficile assay should be performed upon admission to exclude infectious causes of colitis.

Statement 6.6

For patients admitted with acute severe colitis, limited flexible sigmoidoscopy, when indicated, should be performed without bowel preparation by an experienced endoscopist.

Statement 6.7

All patients with acute severe colitis not settling on intravenous steroids should be assessed regularly by a consultant adult/paediatric colorectal surgeon and a decision made with the patient and adult/paediatric gastroenterologist on day three to escalate to rescue therapy or undertake a colectomy.

Why is it important?

Acute severe colitis is a potentially life-threatening condition. Between 15-25% of patients with Ulcerative Colitis will need to be hospitalised due to an acute, severe flare up at some stage of their journey. Often this will be the first presentation of their disease.

When a flare occurs in colitis, it can change and deteriorate rapidly. Patients need fast and close monitoring and review by appropriate specialists. Children experiencing an acute episode need immediate access to a paediatric gastroenterologist.

The monitoring stage should include stool cultures to exclude infectious causes, as well as flexible sigmoidoscopy. When it comes to escalating from intravenous steroids to ciclosporin or infliximab rescue therapy or to surgery, it’s important to make decisions quickly to avoid severe complications. (Intravenous steroids will fail for nearly half of patients.)

If the disease doesn’t respond to medical therapy, the side effects of medication are intolerable, or there’s a life-threatening haemorrhage, toxic megacolon or perforation, an emergency subtotal colectomy should be performed.

I was given 11 days of intravenous steroids and not offered any rescue therapy. I ended up collapsing in the toilet before a subtotal colectomy was performed – it’s taken a long time to process what happened.

Nancy, patient presenting with acute severe colitis