What is the emergency management of colitis?

From the Guidelines

The emergency management of colitis should prioritize stabilizing the patient, controlling inflammation, and preventing complications, with a focus on early surgical consultation for patients with severe disease or those who progress to systemic toxicity, as recommended by the most recent guidelines 1. The initial steps in managing colitis include:

• Fluid resuscitation with intravenous crystalloids to correct dehydration and electrolyte imbalances
• Pain management using acetaminophen or, if necessary, opioids like hydromorphone 0.5-1mg IV every 4-6 hours
• Antibiotic therapy, such as metronidazole, oral or intraluminal vancomycin, and oral fidaxomicin, for symptomatic cases with a positive stool C. difficile test, as suggested by Sartelli et al. 1
• Corticosteroids, such as methylprednisolone or hydrocortisone, for acute treatment, although their use is more established in ulcerative colitis than in infectious colitis like Clostridioides difficile Key considerations in the emergency management of colitis include:
• Early surgical consultation for patients with severe disease or those who progress to systemic toxicity, as recommended by the guidelines 1
• The use of subtotal colectomy with ileostomy as the surgical treatment of choice in patients with acute severe ulcerative colitis presenting with massive colorectal hemorrhage or non-responders to medical treatment, as suggested by the guidelines 1
• The potential benefits of diverting loop ileostomy with colonic antibiotic lavage as an effective alternative to subtotal colectomy, as recommended by the guidelines 1
• The importance of a multidisciplinary approach, including gastroenterologists and surgeons, in the management of acute severe colitis, as emphasized by the guidelines 1

From the FDA Drug Label

WARNING: SERIOUS INFECTIONS and MALIGNANCY Increased risk of serious infections leading to hospitalization or death, including tuberculosis (TB), bacterial sepsis, invasive fungal infections (such as histoplasmosis) and infections due to other opportunistic pathogens. (5. 1) Discontinue AVSOLA if a patient develops a serious infection.

The FDA drug label does not answer the question.

From the Research

Emergency Disposition Colitis

Overview of Management

• The management of ulcerative colitis (UC) involves a multidisciplinary approach, including both medical and surgical treatments 2.
• Patients with acute severe ulcerative colitis are at high risk for life-threatening complications and emergency colectomy, and require prompt evaluation and treatment 3, 4.

Medical Management

• Corticosteroids remain the first-line therapy for acute severe ulcerative colitis, with second-line medical rescue options including infliximab or cyclosporine considered within 3-5 days of presentation 2, 4.
• Intravenous corticosteroids can be effective in inducing remission in moderately active UC unresponsive to oral corticosteroids, but may be associated with steroid-dependency in some patients 5.
• Newer formulations of gut-selective corticosteroids have reduced adverse effects associated with steroids 6.

Surgical Management

• Early surgical consultation is important to present the possibility of a staged proctocolectomy as one of the therapeutic options for patients with acute severe ulcerative colitis 2.
• Colectomy may be required as a salvage option in patients with disease progression despite aggressive treatment, or complications such as megacolon, perforation, or hemorrhage 4.

Multidisciplinary Approach

• A coordinated multidisciplinary approach to treatment, involving the patient's preferences throughout the process, is optimal in providing patient-centered effective care 2.
• The management of UC should involve a team of healthcare professionals, including gastroenterologists, surgeons, and other specialists, to provide comprehensive care for patients with this condition 2, 3.