Chinese research into severe ulcerative colitis has increased in quantity and complexity

Luo, Cheng-Xin; Wen, Zhong-Hui; Zhen, Yu; Wang, Zhu-Jun; Mu, Jing-Xi; Zhu, Min; Ouyang, Qin; Zhang, Hu

Ulcerative colitis (UC) is a chronic idiopathic inflammatory disease characterized by relapsing and remitting mucosal inflammation in the colon [1] . About 15%-25% of all UC patients experience at least one severe exacerbation requiring hospitalization [2] . Severe UC (SUC) is a potentially life-threatening condition which is defined as six or more bloody stools per day plus at least one of the following of Truelove and Witts' criteria: Fever (temperature > 37.8 ℃); tachycardia (pulse rate > 90 bpm); anemia (hemoglobin ≤ 75% of normal); and elevated erythrocyte sedimentation rate (ESR > 30 mm/h) [2, 3] . Intravenous corticosteroid remains the first-line therapy for SUC, having been reported to reduce the mortality rate from 24% to 7% [4, 5] . However, 30%-40% of patients have disease which is steroidrefractory, requiring more invasive treatment [6, 7] . The overall colectomy rate in SUC patients is higher than 30%, according to a cohort study [8] . However, in cases that fail to response to steroid therapy [stool frequency >8 stools/d, or 3-8 stools/d together with a C-reactive protein (CRP) > 45 mg/L on day 3], the colectomy rate is 85% [9] . Salvage therapy with either infliximab or cyclosporin appears to improve clinical outcomes for cases of steroid therapy failure in randomized controlled trials [10] . Patients who do not respond to intensive medical therapy or with severe complications including toxic megacolon, perforation and severe hemorrhage should be considered for timely surgery. Delayed surgery is associated with increased mortality and a higher risk of postoperative complications [11, 12] . Therefore it is of paramount importance to assess the response to therapy regularly, using standardized criteria, and to initiate optimal therapy options promptly. Above all, effective management of SUC remains a great challenge.