{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T01:02:42Z","timestamp":1768266162297,"version":"3.49.0"},"reference-count":32,"publisher":"FapUNIFESP (SciELO)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ABCD, arq. bras. cir. dig."],"published-print":{"date-parts":[[2016,9]]},"abstract":"<jats:p>ABSTRACT  Introduction: Acute severe colitis is a potentially lethal medical emergency and, even today, its treatment remains a challenge for clinicians and surgeons. Intravenous corticoid therapy, which was introduced into the therapeutic arsenal in the 1950s, continues to be the first-line treatment and, for patients who are refractory to this, the rescue therapy may consist of clinical measures or emergency colectomy.  Objective: To evaluate the indications for and results from drug rescue therapy (cyclosporine, infliximab and tacrolimus), and to suggest a practical guide for clinical approaches.  Methods:  The literature was reviewed using the Medline\/PubMed, Cochrane library and SciELO databases, and additional information from institutional websites of interest, by cross-correlating the following keywords: acute severe colitis, fulminating colitis and treatment.  Results:  Treatments for acute severe colitis have avoided colectomy in 60-70% of the cases, provided that they have been started early on, with multidisciplinary follow-up. Despite the adverse effects of intravenous cyclosporine, this drug has been indicated in cases of greater severity with an imminent risk of colectomy, because of its fast action, short half-life and absence of increased risk of surgical complications. Therapy using infliximab has been reserved for less severe cases and those in which immunosuppressants are being or have been used (AZA\/6-MP). Indication of biological agents has recently been favored because of their ease of therapeutic use, their good short and medium-term results, the possibility of maintenance therapy and also their action as a \"bridge\" for immunosuppressant action (AZA\/6-MP). Colectomy has been reserved for cases in which there is still no response five to seven days after rescue therapy and in cases of complications (toxic megacolon, profuse hemorrhage and perforation).  Conclusion:  Patients with a good response to rescue therapy who do not undergo emergency operations should be considered for maintenance therapy using azathioprine. A surgical procedure is indicated for selected cases.<\/jats:p>","DOI":"10.1590\/0102-6720201600030017","type":"journal-article","created":{"date-parts":[[2016,10,15]],"date-time":"2016-10-15T17:34:46Z","timestamp":1476552886000},"page":"201-205","source":"Crossref","is-referenced-by-count":21,"title":["MANAGEMENT OF ACUTE SEVERE ULCERATIVE COLITIS: A CLINICAL UPDATE"],"prefix":"10.1590","volume":"29","author":[{"given":"Carlos Walter","family":"SOBRADO","sequence":"first","affiliation":[{"name":"University of S\u00e3o Paulo,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucas Faraco","family":"SOBRADO","sequence":"additional","affiliation":[{"name":"University of S\u00e3o Paulo,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"530","reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"1532","DOI":"10.1002\/ibd.21225","article-title":"Simple score to identify colectomy risk in ulcerative colitis hospitalizations","volume":"16","author":"Ananthakrishnan NA","year":"2010","journal-title":"Inflamm Bowel Dis"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1111\/j.1572-0241.2006.00524.x","article-title":"Tracolimus is safe and effective in patients with severe steroid-refractory or steroid-dependent inflammatory bowel disease-a long-term follow-up","volume":"101","author":"Baumgart DC","year":"2006","journal-title":"Am J Gastroenterol"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1111\/j.1572-0241.2000.02019.x","article-title":"multiple organ dysfunction in ulcerative colitis","volume":"95","author":"Caprilli L","year":"2000","journal-title":"Am J Gastroenterol"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"1587","DOI":"10.1111\/j.1572-0241.1999.01149.x","article-title":"Intravenous cyclosporine in ulcerative colitis a five-year experience","volume":"94","author":"Cohen RD","year":"1999","journal-title":"Am J Gastroenterol"},{"issue":"4","key":"ref5","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/j.crohns.2010.02.001","article-title":"The pattern and outcome of acute severe colitis","volume":"4","author":"Dinesen LC","year":"2010","journal-title":"J Crohns Colitis"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1136\/gut.4.4.299","article-title":"The course and prognosis of ulcerative colitis","volume":"4","author":"Edward FC","year":"1963","journal-title":"Gut"},{"key":"ref7","first-page":"1137","article-title":"Clinical patterns, natural history, and progression of ulcerative colitis A long-term follow-up of 1116 patients","volume":"38","author":"Farme RG","year":"1993","journal-title":"Dig Dis Sci"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1097\/00054725-200209000-00002","article-title":"Response of refractory colitis to intravenous or oral tracolimus (FK506)","volume":"8","author":"Fellermann K","year":"2002","journal-title":"Inflamm Bowel Dis"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"2363","DOI":"10.1111\/j.1572-0241.2003.07696.x","article-title":"A new look at toxic megacolon an update and review of incidence, etiology, pathogenesis, and management","volume":"98","author":"Gan SI","year":"2003","journal-title":"Am J gastroenterol"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1111\/j.1365-2036.2010.04435.x","article-title":"Clinical trial colectomy after rescue therapy in ulcerative colitis-3-year follow-up of the Swedish-Danish controlled infliximab study","volume":"32","author":"Gustavsson S","year":"2010","journal-title":"Aliment Pharmacol Ther"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"1805","DOI":"10.1053\/j.gastro.2005.03.003","article-title":"Infliximab as rescue therapy in severe to moderately severe ulcerative colitis a randomized, placebo-controlled study","volume":"128","author":"Jarnerot G","year":"2005","journal-title":"Gastroenterology"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1053\/j.gastro.2008.01.004","article-title":"Impacto f hospital volume on postoperative morbidity and mortality following a colectomy for ulcerative colitis","volume":"134","author":"Kaplan GG","year":"2008","journal-title":"Gastroenterology"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1111\/j.1365-2036.2007.03415.x","article-title":"Infliximab in severe ulcerative colitis short-term results of different infusion regimens and long-term follow-up","volume":"26","author":"Kohn A","year":"2007","journal-title":"Aliment Pharmacol Ther"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1038\/ajg.2009.727","article-title":"Ulcerative colitis practice guidelines in adults: American College of Gastroenterology, Practice parameters Committee","volume":"105","author":"Kornbluth A","year":"2010","journal-title":"Am J Gastroenterol"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"1909","DOI":"10.1016\/S0140-6736(12)61084-8","article-title":"Cyclosporine versus infliximab in patients with severe ulcerative colitis refractory to intravenous steroids: a parallel, open-label randomized controlled trial","volume":"380","author":"Laharie D","year":"2012","journal-title":"Lancet"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1136\/gut.16.8.579","article-title":"Assessment of severity in colitis a preliminary study","volume":"16","author":"Lennard-Jones JE","year":"1975","journal-title":"Gut"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"1841","DOI":"10.1056\/NEJM199406303302601","article-title":"Cyclosporine in severe ulcerative colitisrefractory to steroid therapy","volume":"330","author":"Lichtiger S","year":"1994","journal-title":"N Engl J Med"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1016\/j.cgh.2006.04.001","article-title":"Incidence of colectomy during long-term follow-up after cyclosporine-induced remission of severe ulcerative colitis","volume":"4","author":"Moskoviotz DN","year":"2006","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1136\/gut.52.7.998","article-title":"Infliximab in moderately severe glucocorticoid resistant ulcerative colitis a randomized controlled trial","volume":"52","author":"Probert CS","year":"2003","journal-title":"Gut"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1097\/00004836-199002000-00011","article-title":"High-dose methylprednisolone in the treatment of active ulcerative colitis","volume":"12","author":"Rosenberg W","year":"1990","journal-title":"J Clin Gastroenterol"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1097\/00054725-200105000-00001","article-title":"Infliximab in the treatment of severe, steroid refractory ulcerative colitis a pilot study","volume":"7","author":"Sands BE","year":"2001","journal-title":"Inflamm Bowel disease"},{"key":"ref22","series-title":"Trough serum infliximab: a predictive factor of clinical outcome for","author":"Seow CH"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1136\/gut.2009.183095","article-title":"infliximab treatment in acute ulcerative colitis","volume":"59","year":"2010","journal-title":"Gut"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/S0140-6736(97)10475-5","article-title":"Toxic megacolon","volume":"351","author":"Sheth SG","year":"1998","journal-title":"Lancet"},{"key":"ref25","first-page":"CD004277","article-title":"Cyclosporine A for induction of remission in severe ulcerative colitis","author":"Shibolet O","year":"2005","journal-title":"Cochrane Database Syst Rev"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"65S","DOI":"10.1007\/BF01538133","article-title":"Role of inflammatory mediators in colonic smooth muscle function in ulcerative colitis","volume":"33","author":"Snape W Jr J","year":"1988","journal-title":"Dig Dis Sci"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1111\/j.1572-0241.2007.01718.x","article-title":"Adverse events associated with the use of cyclosporine in patients with inflammatory bowel disease","volume":"103","author":"Sternthal MB","year":"2008","journal-title":"Am J Gastroenterol"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1007\/s002689900354","article-title":"Role of nitric oxide in the colon of patients with ulcerative colitis","volume":"22","author":"Tomita R","year":"1998","journal-title":"World J Surg"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1136\/bmj.2.4947.1041","article-title":"Cortisone in ulcerative colitis final report on a therapeutic trial","volume":"2","author":"Truelove SC","year":"1955","journal-title":"Br Med J"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1136\/gut.38.6.905","article-title":"Predicting outcome in severe ulcerative colitis","volume":"38","author":"Travis SP","year":"1996","journal-title":"Gut"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.cgh.2006.09.033","article-title":"Response to corticosteroids in severe ulcerative colitis a systematic review of the literatureand a meta-regression","volume":"5","author":"Turner D","year":"2007","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref32","first-page":"1025","article-title":"Randomized double-blind comparison of 4 mg\/kg versus 2 mg\/kg intravenous cyclosporine in severe ulcerative colitis","volume":"125","author":"Van Assche G","year":"2003","journal-title":"Gastroenterology"}],"container-title":["ABCD. Arquivos Brasileiros de Cirurgia Digestiva (S\u00e3o Paulo)"],"original-title":[],"link":[{"URL":"http:\/\/www.scielo.br\/pdf\/abcd\/v29n3\/0102-6720-abcd-29-03-00201.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2017,5,23]],"date-time":"2017-05-23T21:15:40Z","timestamp":1495574140000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S0102-67202016000300201&lng=en&tlng=en"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,9]]},"references-count":32,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2016,9]]}},"alternative-id":["S0102-67202016000300201"],"URL":"https:\/\/doi.org\/10.1590\/0102-6720201600030017","relation":{},"ISSN":["0102-6720"],"issn-type":[{"value":"0102-6720","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,9]]}}}