Acute severe colitis

Acute severe colitis

• Patients with a mild attack usually respond to a course of oral prednisolone. A moderate attack often responds to oral prednisolone, twice-daily steroid enemas and 5-ASA. Failure to achieve remission as an outpatient is an indication for admission. Acute severe colitis occurs in up to 10% of patients, who require hospital admission. Regular assessment of vital signs, weight and the abdomen are required. A stool chart should be kept, regular clinical review is required and supine abdominal radiographs should be done when there is clinical concern for toxic megacolon. The presence of mucosal islands or intramural gas on plain radiographs, increasing colonic diameter or a sudden increase in pulse and temperature may indicate impending colonic perforation. Limited endoscopic assessment and reassessment is useful in monitoring response to treatment. Fluid and electrolyte balance must be maintained, parenterally . Initial treatment is with intravenous steroids. Regular and joint review by a gastroenterologist and a colorectal surgeon is essential to identify patients who are failing to make antici pated progress and to ensure that surgery is neither inappropri ately delayed nor inappropriately undertaken. Patients should be supported by IBD specialist nurses and early introduction to a stoma therapist is considered best practice. Instigation of immunosuppressive therapy with either intravenous ciclosporin A or an anti-TNF α agent ma appropriate; however, surgery should be considered if r therapy does not result in rapid clinical improvement for the patient. Clinical deterioration requires urgent colectomy .