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The Management of the Hospitalized Ulcerative Colitis Patient, the Medical—Surgical Conundrum

  • Inflammatory Bowel Disease (M Regueiro, Section Editor)
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Abstract

Purpose of Review

In this study we present the evidence based management for patients hospitalized for UC with a special focus on the synergic approach of the two key actors of the inflammatory bowel disease multidisciplinary team (IBD-MDT): gastroenterologist and surgeon.

Recent Findings

Focused treatment by a specialized IBD-MDT and early involvement of the colorectal surgeon in the management of hospitalized ulcerative colitis patients is advocated. The colectomy rate has not changed over the years. Moreover delayed surgery after admission is burden by increase complication and mortality. Thus, it is pivotal to identify the patients who are likely to undergo surgery, by mean of predictors of outcome, and to not prolong ineffective medical treatment. The perfect timing based on clinical close monitoring is crucial.

Summary

Up to 25% of patients with ulcerative colitis (UC) may require hospitalization. The aim of admission is to evaluate severity of the disease, exclude infections and establish proper treatment while monitoring the response. During admission, the patient has to be closely observed for the possible development of toxic megacolon or perforation, which should prompt emergency colectomy. Up to 30% of UC patients will fail to respond to initial intravenous corticosteroid. Non responder or partial responder to medical therapy should be evaluated for timely surgery or could be considered for rescue medical therapy.

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy

    Michele Carvello & Antonino Spinelli

  2. Department of General Surgery, Northwick Park Hospital, London, UK

    Joseph Watfah

  3. Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy

    Antonino Spinelli

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Carvello, M., Watfah, J. & Spinelli, A. The Management of the Hospitalized Ulcerative Colitis Patient, the Medical—Surgical Conundrum. Curr Gastroenterol Rep 23, 25 (2021). https://doi.org/10.1007/s11894-021-00820-7

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