Future of Acute Severe Ulcerative Colitis-A Narrative Review

Abstract

While corticosteroids have led to significant reduction in ASUC mortality over the last few decades, they are associated with significant side effects and up to 30% of patients have steroid refractory ASUC, which means we require safer and better therapies for patients with ASUC. Several salvage therapies have been proposed in guidelines; however, we lack high quality head-to-head randomised controlled trials to assess effectiveness and safety of these agents. Furthermore, the role of newer novel agents in ASUC management is unclear. We aim to present an up to date review and envisage future treatment of ASUC without steroids based on current trials and data. In summary, we conclude that ASUC treatment still heavily relies on corticosteroids despite the side effect profile. While infliximab and cyclosporine have extensive data, there are no prospective studies comparing them with corticosteroids as initial therapy. Novel therapies open up the possibility of oral options but require prospective data before any conclusion can be made.

Keywords: acute severe ulcerative colitis; colectomy; intravenous corticosteroids.

Figure 1

Management pathway for ASUC. Adopted from ECCO Consensus statement 2017 [15]. LEGEND: ASUC—acute severe ulcerative colitis. Rx—treatment. K+—potassium. Mg—magnesium. QID—four times a day. CMV—cytomegalovirus.