Côlon & Rectum

, Volume 7, Issue 1, pp 18–26

Prise en charge d’une colite aigüe grave

Dossier Thématique / Thematic File

Résumé

La colite aigüe grave (CAG) est une complication pouvant révéler ou compliquer une maladie inflammatoire chronique de l’intestin, en particulier une rectocolite hémorragique. La CAG représente une urgence médico-chirurgicale pouvant engager le pronostic vital à court terme Son diagnostic repose sur des critères clinico-biologiques. Le bilan initial doit avant tout éliminer une complication grave imposant la chirurgie en urgence et écarter une surinfection digestive, notamment à Clostridium Difficile et cytomégalovirus.

La corticothérapie intraveineuse représente le traitement médical de première intention de la CAG. Néanmoins, elle est inefficace chez un patient sur trois. L’infliximab et la ciclosporine sont envisageables en 2e ligne avec une efficacité comparable et le choix du traitement doit se faire au cas par cas. La colectomie doit être proposée d’emblée en cas de formes sévères et se discuter à chaque étape de la prise en charge thérapeutique en alternative au traitement médical.

Mots clés

Colite aigüe grave Rectocolite hémorragique Corticoïdes Infliximab Ciclosporine Colectomie 

Management of severe acute ulcerative colitis

Abstract

Acute severe colitis is a classic complication of inflammatory bowel disease, especially of ulcerative colitis. It is a short-term life-threatening medical and surgical emergency. Acute severe ulcerative colitis diagnosis is based on clinical and biological criteria. The first medical evaluation should identify serious complications that require surgery in emergency and exclude a bowel infection (especially Clostridium Difficile or cytomegalovirus infections).

In acute severe colitis, intravenous corticosteroids are the conventionnal medical treatment. However, roughly one third of patients are resistant to the treatment. Ciclosporin and infliximab are potential rescue treatments in this case, with a similar efficacy. Colectomy remains the best option in case of complicated acute severe colitis and should be discussed as an option at each stage of the treatment.

Keywords

Acute severe colitis Corticosteroids Infliximab Cyclosporin Colectomy 

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Copyright information

© Springer-Verlag France 2013

Authors and Affiliations

  1. 1.Service de gastro-entérologiehôpital Saint-LouisParisFrance

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