GASTROENTEROLOGY ARTICLE OF THE WEEK
August 27, 2009
Long MD, Plevy SE. Poorly responsive Ulcerative Colitis in the Hospital. Clin Gastroenterol Hepatol 2009;7:635-640.
1. Features that predict a lower likelihood of response to IV corticosteroid during a severe flare of UC include:
a. < 2 BM’s per day
b. dilated bowel on X-rays
c. elevated C-reactive protein
d. low serum albumin
e. Fever
2. Which of the following interventions are synergistic with IV steroids to achieve remission of severe UC
a. TPN and bowel rest
b. 6-MP or azathioprine
c. IV antibiotics
d. Intermittent rather than continuous IV steroids
True or False
3. Patients are considered as non-responsive to IV steroids if a response is not evident after 7 days of IV infusion.
4. Patients who fail IV cyclosporine should have Infliximab added to the regimen.
5. Colonic inflammation in UC is caused by an autoimmune reaction to proteins located in the basilar surface of colonic enterocytes
6. A patient who fails to respond to intensive medical therapy afte 3-4 days should go for emergency total colectomy and ileo-anal pull through
7. TPN and complete bowel rest are complementary to IV steroids in severe UC and are synergistic in achieving a response
8. IV cyclosporine then converted to oral, followed by azathioprine maintenance reduces the need for colectomy after severe UC.
9. The response to IV cyclosporine is faster than to infliximab when used for severe UC flare
10. Surgery rather than IV cyclosporine should be favored for patients that have previously failed to respond to 6-MP or azathioprine