Clin Colon Rectal Surg 2022; 35(01): 066-071
DOI: 10.1055/s-0041-1740030
Review Article

Acute Severe Colitis: The Need for Joint Management between Gastroenterologists and Surgeons

Phillip Fleshner
1   Division of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, California
,
Gil Y. Melmed
1   Division of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, California
› Author Affiliations
Funding None.

Abstract

The management of hospitalized patients with acute, severe ulcerative colitis involves close coordination among a multidisciplinary team. For patients not improving on intravenous corticosteroids, surgical consultation should be sought. The remaining hospital course requires frequent communications between the gastroenterologist managing the medical aspects of care, and the colorectal surgeon involved in planning for potential surgery, to optimize patient outcomes. This comanagement includes joint decision-making around the timing of surgery, minimizing medications associated with postoperative morbidity, addressing nutritional and psychosocial aspects of the patient's condition, and planning for a coordinated postoperative course. In this review, we highlight these aspects of care and the need for coordination and communication between gastroenterologists and surgeons in the management of acute severe colitis.



Publication History

Article published online:
17 January 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Øresland T, Bemelman WA, Sampietro GM. et al; European Crohn's and Colitis Organisation (ECCO). European evidence based consensus on surgery for ulcerative colitis. J Crohn's Colitis 2015; 9 (01) 4-25
  • 2 Sachar DB. Management of acute, severe ulcerative colitis. J Dig Dis 2012; 13 (02) 65-68
  • 3 Windsor A, Michetti P, Bemelman W, Ghosh S. The positioning of colectomy in the treatment of ulcerative colitis in the era of biologic therapy. Inflamm Bowel Dis 2013; 19 (12) 2695-2703
  • 4 Lynch RW, Lowe D, Protheroe A, Driscoll R, Rhodes JM, Arnott ID. Outcomes of rescue therapy in acute severe ulcerative colitis: data from the United Kingdom inflammatory bowel disease audit. Aliment Pharmacol Ther 2013; 38 (08) 935-945
  • 5 Calvet X, Panés J, Alfaro N. et al; Members of Consensus Group. Delphi consensus statement: quality indicators for Inflammatory Bowel Disease Comprehensive Care Units. J Crohn's Colitis 2014; 8 (03) 240-251
  • 6 Satsangi J, Silverberg MS, Vermeire S, Colombel JF. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut 2006; 55 (06) 749-753
  • 7 Silverberg MS, Satsangi J, Ahmad T. et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol 2005; 19 (Suppl A): 5A-36A
  • 8 D'Haens G, Sandborn WJ, Feagan BG. et al. A review of activity indices and efficacy end points for clinical trials of medical therapy in adults with ulcerative colitis. Gastroenterology 2007; 132 (02) 763-786
  • 9 Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, Long MD. ACG clinical guideline: ulcerative colitis in adults. Am J Gastroenterol 2019; 114 (03) 384-413
  • 10 Kimura H, Kunisaki R, Tatsumi K, Koganei K, Sugita A, Endo I. Prolonged medical therapy increases the risk of surgical complications in patients with severe ulcerative colitis. Dig Surg 2016; 33 (03) 182-189
  • 11 Latella G, Vernia P, Viscido A. et al. GI distension in severe ulcerative colitis. Am J Gastroenterol 2002; 97 (05) 1169-1175
  • 12 Spiegel BM, Ho W, Esrailian E. et al. Controversies in ulcerative colitis: a survey comparing decision making of experts versus community gastroenterologists. Clin Gastroenterol Hepatol 2009; 7 (02) 168-174 , 174.e1
  • 13 Byrne CM, Tan KK, Young JM, Selby W, Solomon MJ. Patient and clinician preferences for surgical and medical treatment options in ulcerative colitis. Colorectal Dis 2014; 16 (04) 285-292
  • 14 Bewtra M, Kilambi V, Fairchild AO, Siegel CA, Lewis JD, Johnson FR. Patient preferences for surgical versus medical therapy for ulcerative colitis. Inflamm Bowel Dis 2014; 20 (01) 103-114
  • 15 Baker DM, Lee MJ, Jones GL, Brown SR, Lobo AJ. The informational needs and preferences of patients considering surgery for ulcerative colitis: results of a qualitative study. Inflamm Bowel Dis 2017; 24 (01) 179-190
  • 16 Feuerstein JD, Isaacs KL, Schneider Y, Siddique SM, Falck-Ytter Y, Singh S. AGA Institute Clinical Guidelines Committee. AGA clinical practice guidelines on the management of moderate to severe ulcerative colitis. Gastroenterology 2020; 158 (05) 1450-1461
  • 17 Berinstein JA, Steiner CA, Regal RE. et al. Efficacy of induction therapy with high-intensity tofacitinib in 4 patients with acute severe ulcerative colitis. Clin Gastroenterol Hepatol 2019; 17 (05) 988-990.e1
  • 18 Järnerot G, Hertervig E, Friis-Liby I. et al. Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo-controlled study. Gastroenterology 2005; 128 (07) 1805-1811
  • 19 Lichtiger S, Present DH, Kornbluth A. et al. Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med 1994; 330 (26) 1841-1845
  • 20 Laharie D, Bourreille A, Branche J. et al; Groupe d'Etudes Thérapeutiques des Affections Inflammatoires Digestives. Ciclosporin versus infliximab in patients with severe ulcerative colitis refractory to intravenous steroids: a parallel, open-label randomised controlled trial. Lancet 2012; 380 (9857): 1909-1915
  • 21 Feuerstein JD, Akbari M, Tapper EB, Cheifetz AS. Systematic review and meta-analysis of third-line salvage therapy with infliximab or cyclosporine in severe ulcerative colitis. Ann Gastroenterol 2016; 29 (03) 341-347
  • 22 Narula N, Fine M, Colombel JF, Marshall JK, Reinisch W. Systematic review: sequential rescue therapy in severe ulcerative colitis: do the benefits outweigh the risks?. Inflamm Bowel Dis 2015; 21 (07) 1683-1694
  • 23 Karjalainen EK, Renkonen-Sinisalo L, Mustonen HK, Färkkilä M, Lepistö AH. Restorative proctocolectomy in ulcerative colitis: effect of preoperative immunomodulatory therapy on postoperative complications and pouch failure. Scand J Surg 2021; 110 (01) 51-58
  • 24 Kulaylat AS, Kulaylat AN, Schaefer EW. et al. Association of preoperative anti-tumor necrosis factor therapy with adverse postoperative outcomes in patients undergoing abdominal surgery for ulcerative colitis. JAMA Surg 2017; 152 (08) e171538
  • 25 Elson CO, Layden TJ, Nemchausky BA, Rosenberg JL, Rosenberg IH. An evaluation of total parenteral nutrition in the management of inflammatory bowel disease. Dig Dis Sci 1980; 25 (01) 42-48
  • 26 Seo M, Okada M, Yao T, Furukawa H, Matake H. The role of total parenteral nutrition in the management of patients with acute attacks of inflammatory bowel disease. J Clin Gastroenterol 1999; 29 (03) 270-275
  • 27 Long MD, Barnes EL, Herfarth HH, Drossman DA. Narcotic use for inflammatory bowel disease and risk factors during hospitalization. Inflamm Bowel Dis 2012; 18 (05) 869-876
  • 28 Madbouly KM, Senagore AJ, Remzi FH, Delaney CP, Waters J, Fazio VW. Perioperative blood transfusions increase infectious complications after ileoanal pouch procedures (IPAA). Int J Colorectal Dis 2006; 21 (08) 807-813
  • 29 Subramanian V, Saxena S, Kang JY, Pollok RC. Preoperative steroid use and risk of postoperative complications in patients with inflammatory bowel disease undergoing abdominal surgery. Am J Gastroenterol 2008; 103 (09) 2373-2381
  • 30 Balachandran R, Tøttrup A. Safety of proctocolectomy for ulcerative colitis under elective and non-elective circumstances: preoperative corticosteroid treatment worsens outcome. Dig Surg 2015; 32 (04) 251-257
  • 31 Afzali A, Park CJ, Zhu K. et al. Preoperative use of methotrexate and the risk of early postoperative complications in patients with inflammatory bowel disease. Inflamm Bowel Dis 2016; 22 (08) 1887-1895
  • 32 Subramanian V, Pollok RC, Kang JY, Kumar D. Systematic review of postoperative complications in patients with inflammatory bowel disease treated with immunomodulators. Br J Surg 2006; 93 (07) 793-799
  • 33 Gainsbury ML, Chu DI, Howard LA. et al. Preoperative infliximab is not associated with an increased risk of short-term postoperative complications after restorative proctocolectomy and ileal pouch-anal anastomosis. J Gastrointest Surg 2011; 15 (03) 397-403
  • 34 Kunitake H, Hodin R, Shellito PC, Sands BE, Korzenik J, Bordeianou L. Perioperative treatment with infliximab in patients with Crohn's disease and ulcerative colitis is not associated with an increased rate of postoperative complications. J Gastrointest Surg 2008; 12 (10) 1730-1736 , discussion 1736–1737
  • 35 Mor IJ, Vogel JD, da Luz Moreira A, Shen B, Hammel J, Remzi FH. Infliximab in ulcerative colitis is associated with an increased risk of postoperative complications after restorative proctocolectomy. Dis Colon Rectum 2008; 51 (08) 1202-1207 , discussion 1207–1210
  • 36 Selvasekar CR, Cima RR, Larson DW. et al. Effect of infliximab on short-term complications in patients undergoing operation for chronic ulcerative colitis. J Am Coll Surg 2007; 204 (05) 956-962 , discussion 962–963
  • 37 Cohen BLFP, Kane SV. et al. Anti-tumor necrosis factor therapy is not associated with post-operative infection: results from prospective cohort of ulcerative colitis and Crohn's disease patients undergoing surgery to identify risk factors for postoperative infection I (PUCCINI). Gastroenterology 2019; 156 (06) S80
  • 38 Lau C, Dubinsky M, Melmed G. et al. The impact of preoperative serum anti-TNFα therapy levels on early postoperative outcomes in inflammatory bowel disease surgery. Ann Surg 2015; 261 (03) 487-496
  • 39 Parrish AB, Lopez NE, Truong A, Zaghiyan KN, Fleshner PR. Preoperative serum vedolizumab levels do not impact postoperative outcomes in inflammatory bowel disease. Dis Colon Rectum 2021; 64: 1259-1266
  • 40 Lightner AL, McKenna NP, Moncrief S, Pemberton JH, Raffals LE, Mathis KL. Surgical outcomes in vedolizumab-treated patients with ulcerative colitis. Inflamm Bowel Dis 2017; 23 (12) 2197-2201
  • 41 Lightner AL, Mathis KL, Tse CS. et al. Postoperative outcomes in vedolizumab-treated patients undergoing major abdominal operations for inflammatory bowel disease: retrospective multicenter cohort study. Inflamm Bowel Dis 2018; 24 (04) 871-876
  • 42 Kim JY, Zaghiyan K, Lightner A, Fleshner P. Risk of postoperative complications among ulcerative colitis patients treated preoperatively with vedolizumab: a matched case-control study. BMC Surg 2020; 20 (01) 46
  • 43 Farraye FA, Melmed GY, Lichtenstein GR, Kane SV. ACG clinical guideline: preventive care in inflammatory bowel disease. Am J Gastroenterol 2017; 112 (02) 241-258
  • 44 Häuser W, Janke KH, Klump B, Hinz A. Anxiety and depression in patients with inflammatory bowel disease: comparisons with chronic liver disease patients and the general population. Inflamm Bowel Dis 2011; 17 (02) 621-632
  • 45 Thakur ER, Sansgiry S, Kramer JR. et al. The incidence and prevalence of anxiety, depression, and post-traumatic stress disorder in a national cohort of US Veterans with inflammatory bowel disease. Inflamm Bowel Dis 2020; 26 (09) 1423-1428