Acute severe ulcerative colitis: defining the precise moment for colectomy.

IF 3.8 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Expert Review of Gastroenterology & Hepatology Pub Date : 2025-01-03 DOI:10.1080/17474124.2024.2448451

Paulo Gustavo Kotze, Sailish Honap, Mariane Christina Savio, Rafaela Molteni Moretti Araújo, Abel Botelho Quaresma, Laurent Peyrin-Biroulet

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Abstract

Introduction: Acute severe ulcerative colitis (ASUC) is a critical manifestation of ulcerative colitis (UC), often necessitating colectomy when medical management fails. Despite advancements in therapeutic interventions such as corticosteroids, biologics, and JAK inhibitors, a significant proportion of patients require surgery, with colectomy rates ranging from 10% to 15%.

Areas covered: This paper reviews the factors influencing the timing and necessity of colectomy in ASUC management, emphasizing the importance of multidisciplinary decision-making involving gastroenterologists and surgeons.

Expert opinion: Key surgical indications include failure of medical therapy, toxic megacolon, perforation, uncontrolled bleeding, and systemic deterioration. Delays in surgery can result in higher morbidity and mortality rates, making timely intervention essential. This review highlights surgical techniques, including total colectomy and end ileostomy, and discusses potential complications, urging a balanced approach to optimize patient outcomes.

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急性严重溃疡性结肠炎：确定结肠切除术的精确时机。

简介：急性重度溃疡性结肠炎（ASUC）是溃疡性结肠炎（UC）的重要表现，在治疗失败时往往需要结肠切除术。尽管在皮质类固醇、生物制剂和JAK抑制剂等治疗干预措施方面取得了进展，但仍有很大一部分患者需要手术治疗，结肠切除术率在10%至15%之间。涵盖领域：本文回顾了影响ASUC治疗中结肠切除术时机和必要性的因素，强调了包括胃肠病学家和外科医生在内的多学科决策的重要性。专家意见：主要手术指征包括药物治疗失败、中毒性巨结肠、穿孔、不受控制的出血和全身恶化。手术延误可导致更高的发病率和死亡率，因此及时干预至关重要。这篇综述强调了手术技术，包括全结肠切除术和回肠末端造口术，并讨论了潜在的并发症，敦促采用平衡的方法来优化患者的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Expert Review of Gastroenterology & Hepatology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

6.80

自引率

2.60%

发文量

审稿时长

6-12 weeks

期刊介绍： The enormous health and economic burden of gastrointestinal disease worldwide warrants a sharp focus on the etiology, epidemiology, prevention, diagnosis, treatment and development of new therapies. By the end of the last century we had seen enormous advances, both in technologies to visualize disease and in curative therapies in areas such as gastric ulcer, with the advent first of the H2-antagonists and then the proton pump inhibitors - clear examples of how advances in medicine can massively benefit the patient. Nevertheless, specialists face ongoing challenges from a wide array of diseases of diverse etiology.