Colitis – Medical Management

Dr Keith Leiper, The Royal Liverpool and Broadgreen University Hospitals

Consultant Gastroenterologist, Colitis – Medical Management

Recent advances in the management of acute severe colitis may result in fewer colectomies but it must not be at the cost of ‘saving colons- risking lives’. First line therapy remains prompt use of high dose corticosteroids.

A crucial (and often poorly performed) management step is defining steroid failure at the appropriate time (at day 3-5) and making a decision of which of the 3 treatment options- ciclosporin, anti-TNF-a or sugery- is appropriate. Data from the National IBD Audit1 and other observational studies2 suggests that both rescue therapy is under used and that surgery is inappropriately delayed. Medical/surgical team communication and joint management of steroid-failures in acute severe colitis is crucial to successful outcomes. Some of the pifalls in managing acute severe UC will be discussed, including the rise clostridium difficile co-infection, use of heparin, and management of toxic megacolon. Development of effective new therapies for ulcerative colitis has been slow, however some are entering clinical practice, such as apheresis and modified release steroids with improved side-effect profiles.

Leiper K et al. UK Inflammatory Bowel Disease Audit 2006. http://www.rcplondon.ac.uk/college/ceeu/ceeu_uk_ibd_audit_2006.pdf
Roberts SE et al. BMJ. 2007 Nov 17;335(7628):1033