Acute Severe Ulcerative Colitis: Evidence Based Consensus Statements

Acute Severe Ulcerative Colitis: Evidence Based Consensus Statements Abstract Inroduction: Acute severe ulcerative colitis (ASUC) is a potentially life-threatening complication of ulcerative colitis. Intravenous corticosteroid use has significantly improved the mortality rate. However, colectomy rates have remained stable due to limited adoption of rescue medical therapies. Given this and the uncommon but serious nature of the condition, consensus statements based on a systematic review of the literature may assist in the improved outcome of patients with ASUC. Method: The Delphi method was used in the development of the consensus statements. A steering committee generated the statements of interest. Five levels of agreement were used: A: agree completely; B: agree with minor reservation; C: agree with major reservation; D: reject with some reservation, E: reject completely. ≥80% agreement of level A and B determined acceptance of statements. Three rounds of anonymous voting were carried out to achieve the final results. Level of evidence and grade of recommendation were endorsed following further discussion. Results: A total of 33 statements were developed. From 22 multi-disciplinary clinicians, there was 100% agreement for 24 out of 33 statements; 80-99% for 6 statements; and 3 statements were rejected. Key recommendations include that patients with ASUC should be: hospitalised, undergo unprepared flexible sigmoidoscopy to assess severity and to exclude cytomegalovirus colitis, and be provided with venous thromboembolism prophylaxis and intravenous hydrocortisone 100mg 3 or 4 times daily with close monitoring by a multidisciplinary team. Rescue therapy such as infliximab or cyclosporin should be started if insufficient response by day 3, and colectomy considered if no response to 7 days of rescue therapy or earlier if deterioration. With such an approach it is expected that colectomy rate during admission will be below 30% and mortality less than 1% in specialist centres. Conclusion: These evidenced-based consensus statements on ASUC developed by a multidisciplinary group provide up-to-date best practice recommendations that improve and harmonise management as well as provide auditable quality assessments