Review article

Acute severe ulcerative colitis - Evidence-based consensus statements

Jo-Hua Chen, Jane M Andrews, Viraj Kariyawasam, Neil Moran, Praveen Gounder, Glen Collins, Alissa J Walsh, Susan Connor, Thomas W.T. Lee, Cherry E Koh, Jeff Chang, Sudarshan Paramsothy, Stephen Tattersall, Daniel Avi Lemberg, Graham Radford-Smith, Ian C. Lawrance, Andrew McLachlan, G T Moore, Crispin John Corte, P Katelaris & 2 others R Leong, Australian Inflammatory Bowel Diseases Consensus Working Group

Research output: Contribution to journalArticleResearchpeer-review

24 Citations (Scopus)

Abstract

Background Acute severe ulcerative colitis (ASUC) is a potentially life-threatening complication of ulcerative colitis. Aim To develop consensus statements based on a systematic review of the literature of the management of ASUC to improve patient outcome. Methods Following a literature review, the Delphi method was used to develop the consensus statements. A steering committee, based in Australia, generated the statements of interest. Three rounds of anonymous voting were carried out to achieve the final results. Acceptance of statements was pre-determined by ≥80% votes in 'complete agreement' or 'agreement with minor reservation'. Results 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 100 mg three or four times daily with close monitoring by a multidisciplinary team. Rescue therapy such as infliximab or ciclosporin 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 acute severe ulcerative colitis, developed by a multidisciplinary group, provide up-to-date best practice recommendations that improve and harmonise management as well as provide auditable quality assessments.
Original languageEnglish
Pages (from-to)127-144
Number of pages18
JournalAlimentary Pharmacology and Therapeutics
Volume44
Issue number2
DOIs
Publication statusPublished - Jul 2016

Cite this

Chen, J-H., Andrews, J. M., Kariyawasam, V., Moran, N., Gounder, P., Collins, G., ... Australian Inflammatory Bowel Diseases Consensus Working Group (2016). Review article: Acute severe ulcerative colitis - Evidence-based consensus statements. Alimentary Pharmacology and Therapeutics, 44(2), 127-144. https://doi.org/10.1111/apt.13670
Chen, Jo-Hua ; Andrews, Jane M ; Kariyawasam, Viraj ; Moran, Neil ; Gounder, Praveen ; Collins, Glen ; Walsh, Alissa J ; Connor, Susan ; Lee, Thomas W.T. ; Koh, Cherry E ; Chang, Jeff ; Paramsothy, Sudarshan ; Tattersall, Stephen ; Lemberg, Daniel Avi ; Radford-Smith, Graham ; Lawrance, Ian C. ; McLachlan, Andrew ; Moore, G T ; Corte, Crispin John ; Katelaris, P ; Leong, R ; Australian Inflammatory Bowel Diseases Consensus Working Group. / Review article : Acute severe ulcerative colitis - Evidence-based consensus statements. In: Alimentary Pharmacology and Therapeutics. 2016 ; Vol. 44, No. 2. pp. 127-144.
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title = "Review article: Acute severe ulcerative colitis - Evidence-based consensus statements",
abstract = "Background Acute severe ulcerative colitis (ASUC) is a potentially life-threatening complication of ulcerative colitis. Aim To develop consensus statements based on a systematic review of the literature of the management of ASUC to improve patient outcome. Methods Following a literature review, the Delphi method was used to develop the consensus statements. A steering committee, based in Australia, generated the statements of interest. Three rounds of anonymous voting were carried out to achieve the final results. Acceptance of statements was pre-determined by ≥80{\%} votes in 'complete agreement' or 'agreement with minor reservation'. Results 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 100 mg three or four times daily with close monitoring by a multidisciplinary team. Rescue therapy such as infliximab or ciclosporin 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 acute severe ulcerative colitis, developed by a multidisciplinary group, provide up-to-date best practice recommendations that improve and harmonise management as well as provide auditable quality assessments.",
author = "Jo-Hua Chen and Andrews, {Jane M} and Viraj Kariyawasam and Neil Moran and Praveen Gounder and Glen Collins and Walsh, {Alissa J} and Susan Connor and Lee, {Thomas W.T.} and Koh, {Cherry E} and Jeff Chang and Sudarshan Paramsothy and Stephen Tattersall and Lemberg, {Daniel Avi} and Graham Radford-Smith and Lawrance, {Ian C.} and Andrew McLachlan and Moore, {G T} and Corte, {Crispin John} and P Katelaris and R Leong and {Australian Inflammatory Bowel Diseases Consensus Working Group}",
year = "2016",
month = "7",
doi = "10.1111/apt.13670",
language = "English",
volume = "44",
pages = "127--144",
journal = "Alimentary Pharmacology and Therapeutics",
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Chen, J-H, Andrews, JM, Kariyawasam, V, Moran, N, Gounder, P, Collins, G, Walsh, AJ, Connor, S, Lee, TWT, Koh, CE, Chang, J, Paramsothy, S, Tattersall, S, Lemberg, DA, Radford-Smith, G, Lawrance, IC, McLachlan, A, Moore, GT, Corte, CJ, Katelaris, P, Leong, R & Australian Inflammatory Bowel Diseases Consensus Working Group 2016, 'Review article: Acute severe ulcerative colitis - Evidence-based consensus statements', Alimentary Pharmacology and Therapeutics, vol. 44, no. 2, pp. 127-144. https://doi.org/10.1111/apt.13670

Review article : Acute severe ulcerative colitis - Evidence-based consensus statements. / Chen, Jo-Hua; Andrews, Jane M; Kariyawasam, Viraj ; Moran, Neil; Gounder, Praveen; Collins, Glen; Walsh, Alissa J; Connor, Susan; Lee, Thomas W.T.; Koh, Cherry E; Chang, Jeff; Paramsothy, Sudarshan; Tattersall, Stephen; Lemberg, Daniel Avi; Radford-Smith, Graham; Lawrance, Ian C.; McLachlan, Andrew; Moore, G T; Corte, Crispin John; Katelaris, P; Leong, R; Australian Inflammatory Bowel Diseases Consensus Working Group.

In: Alimentary Pharmacology and Therapeutics, Vol. 44, No. 2, 07.2016, p. 127-144.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Review article

T2 - Acute severe ulcerative colitis - Evidence-based consensus statements

AU - Chen, Jo-Hua

AU - Andrews, Jane M

AU - Kariyawasam, Viraj

AU - Moran, Neil

AU - Gounder, Praveen

AU - Collins, Glen

AU - Walsh, Alissa J

AU - Connor, Susan

AU - Lee, Thomas W.T.

AU - Koh, Cherry E

AU - Chang, Jeff

AU - Paramsothy, Sudarshan

AU - Tattersall, Stephen

AU - Lemberg, Daniel Avi

AU - Radford-Smith, Graham

AU - Lawrance, Ian C.

AU - McLachlan, Andrew

AU - Moore, G T

AU - Corte, Crispin John

AU - Katelaris, P

AU - Leong, R

AU - Australian Inflammatory Bowel Diseases Consensus Working Group

PY - 2016/7

Y1 - 2016/7

N2 - Background Acute severe ulcerative colitis (ASUC) is a potentially life-threatening complication of ulcerative colitis. Aim To develop consensus statements based on a systematic review of the literature of the management of ASUC to improve patient outcome. Methods Following a literature review, the Delphi method was used to develop the consensus statements. A steering committee, based in Australia, generated the statements of interest. Three rounds of anonymous voting were carried out to achieve the final results. Acceptance of statements was pre-determined by ≥80% votes in 'complete agreement' or 'agreement with minor reservation'. Results 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 100 mg three or four times daily with close monitoring by a multidisciplinary team. Rescue therapy such as infliximab or ciclosporin 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 acute severe ulcerative colitis, developed by a multidisciplinary group, provide up-to-date best practice recommendations that improve and harmonise management as well as provide auditable quality assessments.

AB - Background Acute severe ulcerative colitis (ASUC) is a potentially life-threatening complication of ulcerative colitis. Aim To develop consensus statements based on a systematic review of the literature of the management of ASUC to improve patient outcome. Methods Following a literature review, the Delphi method was used to develop the consensus statements. A steering committee, based in Australia, generated the statements of interest. Three rounds of anonymous voting were carried out to achieve the final results. Acceptance of statements was pre-determined by ≥80% votes in 'complete agreement' or 'agreement with minor reservation'. Results 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 100 mg three or four times daily with close monitoring by a multidisciplinary team. Rescue therapy such as infliximab or ciclosporin 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 acute severe ulcerative colitis, developed by a multidisciplinary group, provide up-to-date best practice recommendations that improve and harmonise management as well as provide auditable quality assessments.

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DO - 10.1111/apt.13670

M3 - Article

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