Review of the management of acute severe colitis in the Northern Trust
Adgey C, Manikpure G.
Department of Gastroenterology, Northern Trust Altnagelvin Hospital.
Acute colitis is a medical emergency and many patients require colectomy despite increasing use of immunomodulators and biologics. Optimum management relies on recognition of the unwell patient and early consideration for step up treatment in steroid non-responders.
The aim of this study is to evaluate outcome of acute ulcerative colitis in NHSCT and use of rescue infliximab
A retrospective study was carried out involving patient who presented with acute colitis as per Truelove and Witt criteria between Aug 2014 and Jan 2015. Clinical notes were reviewed for demographic and biochemical data. Day 0 and day 3 data was examined for stool frequency, CRP, temperature, pulse and haemoglobin. The primary outcome was response to hydrocortisone. If the patient did not respond then the notes were reviewed for the next modality used and the final outcome
There were 10 patients admitted with a severe flare of ulcerative colitis. 70% were men and the average age was 31 yrs with a range of 16-60years old. 50% of the patients had trialled prednisolone in the community All patients were on some form of oral 5ASA, 1 patient was on humira and methotrexate, one patient was on infliximab and 2 were on azathioprine. All patients had some response to intravenous steroids with the average stool volume falling from 10 on day 0 to 5 on day 3 (p= 0.0002). There was no significant change in temperature from day 0 to day 3 (36.7oC to 36.6oC, p=0.66). Heart rate improved from average of 97.6bpm on day 0 to 76bpm on day 3 however this change was not significant (p=0.075). CRP improved for all patients falling from an average of 90.1 to 34.9 (p= 0.08). Five patients responded completely to hydrocortisone, while five were partial responders needing step up treatment. Their stool volume fell from 9.5 to 7 (p=0.06) and their CRP fell from 66 to 38 (p=0.40). One patient developed toxic megacolon while on biologics. The three biologic naive patients received infliximab therapy with successful outcomes; the two who were already getting biologics went for surgery Mean hospital stay was 4 days for the patients who responded to IV hydrocortisone, 7 days for the infliximab patients and 24.5 days for the patients who required surgery.
Overall 50% of patients responded to steroid therapy, 20% needed Surgery and 30% were rescued with infliximab. Patients who received biologics had significantly lower hospital stays compared with surgery.