The Writing Is on the Wall: The Utility of Mural Stratification for Risk Stratification of Hospitalized Patients with Severe Ulcerative Colitis

Excerpt

Ulcerative colitis (UC), a form of inflammatory bowel disease (IBD), is a chronic inflammatory disease affecting the colonic mucosa, involving, in the majority of cases, the rectum and more proximal colonic segments in a continuous pattern. An assessment of disease severity based on clinical and laboratory studies is crucial in the formulation of a treatment plan for patients with symptoms suggestive of UC [1]. Within 2 years of diagnosis, 20% of patients with UC require hospitalization. Patients admitted to hospital should be evaluated for the severity and anatomical extent of disease in order to help predict the disease course. Pancolitis is associated with a higher rate of failure of medical treatment and an increased rate of colectomy [2]. Stool frequency, colonic dilatation, and hypoalbuminemia are predictors of failure of intravenous corticosteroid treatment, enabling early identification of patients with severe UC who could benefit from second-line medical therapy or surgery [3]. More specifically, this subgroup of patients should be treated early with intravenous glucocorticoids, fluids and electrolyte restoration, and broad-spectrum antibiotics without delay until the results of stool studies and cultures are available. Among those patients who are hospitalized, nearly one-third are unresponsive to intravenous corticosteroids, requiring rescue therapy with infliximab, cyclosporine, or emergent colectomy [4]. Patients with fulminant ulcerative colitis who do not respond by the third day of intensive treatment should be managed with either cyclosporine (CsA; a calcineurin inhibitor), or infliximab to induce and maintain remission or undergo rescue colectomy. …