VIDEO: Surgery delay leads to complications in severe ulcerative colitis
CHICAGO — In this exclusive video from the 2019 Interdisciplinary Autoimmune Summit, Adam Cheifetz, MD, director of the Center for Inflammatory Bowel Disease at Beth Israel Deaconess Medical Center, discusses his presentation on the management of patients with severe ulcerative colitis.
“We are going to see it in at least 10% to 15% of our patients,” Cheifetz told Healio Gastroenterology and Liver Disease. “It is a medical emergency. These patients need hospitalization, they need an expedited workup and they need treatment.”
Cheifetz said the first few days are crucial in determining outcomes for patients. While many will respond to treatment with intravenous corticosteroids, those who do not will need salvage therapy with Remicade (infliximab, Janssen) or cyclosporine.
The decision to move a patient on to surgery will typically need to occur fairly early, Cheifetz said. Checking patients’ C-reactive protein and the number of bowel movements should give a good indication of who is going to fail that initial steroid therapy.
“If they are failing, it is not a bad thing to send these patients to surgery,” Cheifetz said. “Delaying surgery is where we see a lot of the complications of this disease. So, you have to work closely with your colorectal surgeon to determine the best time for surgery.”
Disclosures: Cheifetz reports being a consultant for AbbVie, Arena, Arsanis, Bacainn, EMD Serono, Grifols, Janssen, Pfizer, Prometheus, Samsung and Takeda. He also reports grant/research support from Inform Diagnostics.