PDF(Pubmed)
Abstract：
Acute Severe Ulcerative Colitis (ASUC) is a severe form of ulcerative colitis relapse which requires hospitalization and intensive medical intervention to avoid colectomy. The timely recognition of patients at risk of corticosteroid failure and the early initiation of medical rescue therapy are paramount in the management of ASUC. The choice of medical rescue therapy is influenced by multiple factors, especially patient\'s prior treatment history. This decision should involve the patient and ideally a multidisciplinary team of healthcare professionals, including gastroenterologists, radiologists, surgeons and enterostomal therapists. Although several predictive models have been developed to predict corticosteroid failure in ASUC, there is no single validated tool that is universally utilized. At present, infliximab and cyclosporine are the only agents systematically evaluated and recommended for medical rescue therapy, with recent reports of off-label utilization of tofacitinib and upadacitinib in small case series. The available evidence regarding the efficacy and safety of these oral small molecules for ASUC is insufficient to provide definitive recommendations. Early decision-making to assess the response to medical rescue therapy is essential, and the decision to pursue surgery in the case of treatment failure should not be delayed.
摘要：
急性重度溃疡性结肠炎（ASUC）是溃疡性结肠炎复发的一种严重形式，需要住院治疗和强化医疗干预以避免结肠切除术。在ASUC的管理中，及时识别有皮质类固醇激素衰竭风险的患者并尽早开始医学抢救治疗至关重要。医疗救援疗法的选择受多种因素的影响,尤其是患者的既往治疗史。此决定应涉及患者，最好是多学科的医疗保健专业人员团队，包括胃肠病学家,放射科医生,外科医生和肠造口治疗师。尽管已经开发了几种预测模型来预测ASUC中的皮质类固醇衰竭，没有一个单一的验证工具是普遍使用的。目前,英夫利昔单抗和环孢素是唯一系统评估和推荐用于医疗救援治疗的药物，最近有报道称，托法替尼和upadacitinib在小病例系列中的标签外使用。关于这些口服小分子用于ASUC的功效和安全性的现有证据不足以提供明确的建议。早期决策评估对医疗救援治疗的反应至关重要，在治疗失败的情况下进行手术的决定不应延迟。
