Abstract
Ulcerative Colitis (UC) is a chronic inflammatory disease involving the colon, with alternating periods of remission and activity. Exacerbations can be severe and associated with complications and mortality. Diagnosis of severe UC is based on clinical, biochemical and endoscopic variables. Patients with severe UC must be hospitalized. First line therapy is the use of intravenous corticoids which achieve clinical remission in most patients. However, 25% of patients will be refractory to corticoids, situation that should be evaluated at the third day of therapy. In patients without response, cytomegalovirus infection must be quickly ruled out to escalate to second line therapy with biological drugs or cyclosporine. Total colectomy must not be delayed if there is no response to second line therapy, if there is a contraindication for second line therapies or there are complications such as: megacolon, perforation or massive bleeding. An active management with quick escalation on therapy allows to decrease the prolonged exposure to corticoids, reduce colectomy rates and its perioperative complications.
Highlights
Cytomegalovirus infection must be quickly ruled out to escalate to second line therapy with biological drugs or cyclosporine
Total colectomy must not be delayed if there is no response to second line therapy, if there is a contraindication for second line therapies or there are complications such as: megacolon, perforation or massive bleeding
An active management with quick escalation on therapy allows to decrease the prolonged exposure to corticoids, reduce colectomy rates and its perioperative complications. (Rev Med Chile 2017; 145: 96-105) Key words: Colitis, Ulcerative; Colonic Diseases; Drug Therapy; Inflammatory Bowel Diseases
Summary
First line therapy is the use of intravenous corticoids which achieve clinical remission in most patients. (Rev Med Chile 2017; 145: 96-105) Key words: Colitis, Ulcerative; Colonic Diseases; Drug Therapy; Inflammatory Bowel Diseases. De los pacientes con crisis grave, 20 a 30% no responderá al uso de corticoides intravenosos y de ellos, 80% requerirá colectomía[2]. El objetivo de este artículo es revisar y difundir el manejo actual de la crisis grave de CU. En la Tabla 1 se señalan los exámenes mínimos que deben realizarse a todo paciente con crisis grave de CU, sin excluir la necesidad de otras evaluaciones según la condición clínica del paciente y el criterio del médico tratante. Exámenes mínimos a realizar en pacientes con crisis grave de colitis ulcerosa
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