Acute severe colitis- how to resolve?

[Moucheta]

Hi, my 44 year old male teacher who is married, has two children, is suffering from diarrhea for three months. Bouts of diarrhea were occurring up to 10 times a day with blood apparent in the feces. Diarrhea was associated with pushing, rectal tenesmus, asymmetric polyarthralgia in large joints (elbow and knee), skin rash on the lower limbs, fatigue, weakness, 5 kg weight loss and pallor. A colonoscopy done one month earlier had shown left ulcerative colitis. This was confirmed with a biopsy. How to resolve this?

[Lagnajita]

@moucheta The management of acute severe ulcerative colitis depends on early recognition of the unwell patient with colitis, the prompt initiation of treatment and objective assessment of the likelihood of medical failure. This deters ‘hopeful expectation’ in an attempt to avoid surgery. Intravenous corticosteroids remain first-line therapy but are completely effective in only 40%, partially effective in 30% and around 30% come to colectomy. The decision to use ciclosporin or infliximab for those with a poor response to steroids should be made at an early stage, often 3 or 4 days after starting intensive therapy. Decision-making is becoming more difficult with agents such as visilizumab, tacrolimus and the technique of leucocytapheresis as further options. Nevertheless, intravenous corticosteroids and timely colectomy have reduced mortality from nearly 30% to <1% in specialist centres. Ciclosporin has delayed the need for urgent colectomy in many patients, but long-term follow-up suggests the majority come to colectomy within 7 years. Long-term outcome with newer agents, including infliximab, is not yet known.