| Theme | Advanced Therapy Ulcerative Colitis | |
|---|---|---|
| Title | TGMedical Treatment for Ulcerative Colitis : Intravenous Steroid Infusion Therapy | |
| Publish Date | 1997/09 | |
| Author | Susumu Kurosawa | Third Department of Internal Medicine, Teikyo University, Ichihara Hospital |
| Author | Takashi Nakamura | Third Department of Internal Medicine, Teikyo University, Ichihara Hospital |
| [ Summary ] | Parenteral glucocorticoid treatment is indicated for severe to fulminant active ulcerative colitis. The diagnosis of severe or fulminant ulcerative colitis is made primarily by clinical symptoms such as fever. Frequency of bloody stool, tachycardia combined with simple laboratory data such as anemia and increased ESR. If not treated properly, disastrous results may ensue. The treatment method was originated by Truelove in 1955 and several improvements were made thereafter. In Japan, the National Ministry of Health described this treatment in "The guidelines for the treatment of ulcerative colitis." Some investigators advocate the efficacy of parenteral glucocorticoid pulse therapy over conventional intravenous therapy because there is no need for corticoid tapering and there are few side effects. However, to date, there has been no definitive evidence of the superiority of pulse therapy over conventional intravenous therapy. Further study is needed. The key point in treatment is to start the intravenous prednisolone at as high a dose as possible and to estimate the result by clinical parameters such as bloody stool, fever or pulse. If the patient does not show a satisfactory response, emergent colectomy should be performed. The discussion for medical versus surgical treatment can finally be made by a trial of parenteral gulcocorticoid treatment. Because ulcerative colitis is curable with colectomy, in contrast to Crohn's disease, parenteral gulcocorticoid treatment should be performed keeping these facts in mind. Two cases of ulcerative colitis are presented, one effectively treated by parenteral glucocorticoid therapy and the other by colectomy because parenteral glucocorticoid therapy failed. |
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