Résumé
La colite aigüe grave (CAG) est une complication pouvant révéler ou compliquer une maladie inflammatoire chronique de l’intestin, en particulier une rectocolite hémorragique. La CAG représente une urgence médico-chirurgicale pouvant engager le pronostic vital à court terme Son diagnostic repose sur des critères clinico-biologiques. Le bilan initial doit avant tout éliminer une complication grave imposant la chirurgie en urgence et écarter une surinfection digestive, notamment à Clostridium Difficile et cytomégalovirus.
La corticothérapie intraveineuse représente le traitement médical de première intention de la CAG. Néanmoins, elle est inefficace chez un patient sur trois. L’infliximab et la ciclosporine sont envisageables en 2e ligne avec une efficacité comparable et le choix du traitement doit se faire au cas par cas. La colectomie doit être proposée d’emblée en cas de formes sévères et se discuter à chaque étape de la prise en charge thérapeutique en alternative au traitement médical.
Abstract
Acute severe colitis is a classic complication of inflammatory bowel disease, especially of ulcerative colitis. It is a short-term life-threatening medical and surgical emergency. Acute severe ulcerative colitis diagnosis is based on clinical and biological criteria. The first medical evaluation should identify serious complications that require surgery in emergency and exclude a bowel infection (especially Clostridium Difficile or cytomegalovirus infections).
In acute severe colitis, intravenous corticosteroids are the conventionnal medical treatment. However, roughly one third of patients are resistant to the treatment. Ciclosporin and infliximab are potential rescue treatments in this case, with a similar efficacy. Colectomy remains the best option in case of complicated acute severe colitis and should be discussed as an option at each stage of the treatment.
Article PDF
Avoid common mistakes on your manuscript.
Références
Edwards FC, Truelove SC (1963) The course and prognosis of ulcerative colitis. Gut 4:299–315
Truelove SC, Witts LJ (1955) Cortisone in ulcerative colitis; final report on a therapeutic trial. Br Med J 2:1048
Truelove SC, Jewell DP (1974) Intensive intravenous regimen for severe attacks of ulcerative colitis. Lancet 1:1067–1070
Arts J, D’Haens G, Zeegers M et al (2004). Long-term outcome of treatment with intravenous cyclosporin in patients with severe ulcerative colitis. Inflamm. Bowel Dis 10:73–78
Kohn A, Daperno M, Armuzzi A et al (2007) Infliximab in severe ulcerative colitis: short-term results of different infusion regimens and long-term follow-up. Aliment Pharmacol Ther 26:747–756
Kaplan G, McCarthy EP, Ayanian JZ et al (2008) Impact of hospital volume on postoperative morbidity and mortality following a colectomy for ulcerative colitis. Gastroenterology 134:680–687
Chapman RW, Selby WS, Jewell DP (1986) Controlled trial of intravenous metronidazole as an adjunct to corticosteroids in severe ulcerative colitis. Gut 27:1210–1212
Lichtiger S, Present DH, Kornbluth A et al (1994) Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med 330:1841–1845
D’Haens G, Sandborn WJ, Feagan BG et al (2007) A review of activity indices and efficacy end points for clinical trials of medical therapy in adults with ulcerative colitis. Gastroenterology 132:763–786
Gan SI, Beck PL (2003) A new look at toxic megacolon: an update and review of incidence, etiology, pathogenesis, and management. Am J Gastroenterol 98:2363–2371
Ananthakrishnan AN, McGinley EL, Binion DG (2008) Excess hospitalisation burden associated with Clostridium difficile in patients with inflammatory bowel disease. Gut 57:205–210
Carbonnel F (2007) Management of severe or corticosteroid resistant ulcerative colitis]. Gastroenterol Clin Biol 31:398–403
Carbonnel F, Lavergne A, Lémann M, et al (1994) Colonoscopy of acute colitis. A safe and reliable tool for assessment of severity. Dig Dis Sci 39:1550–1557
Carbonnel F, Boruchowicz A, Duclos B et al (1996) Intravenous cyclosporine in attacks of ulcerative colitis: short-term and longterm responses. Dig Dis Sci 41:2471–2476
Carbonnel F, Gargouri D, Lémann M et al (2000) Predictive factors of outcome of intensive intravenous treatment for attacks of ulcerative colitis. Aliment Pharmacol Ther 14:273–279
Järnerot G, Hertervig E, Friis-Liby I et al (2005) Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo-controlled study. Gastroenterology 128:1805–1811
Leblanc S, Allez M, Seksik P et al (2011) Successive treatment with cyclosporine and infliximab in steroid-refractory ulcerative colitis. Am J Gastroenterol 106:771–777
Marceau C, Alves A, Ouaissi M et al (2007) Laparoscopic subtotal colectomy for acute or severe colitis complicating inflammatory bowel disease: a case-matched study in 88 patients. Surgery 141:640–644
Lichtenstein GR, Cohen R, Yamashita B, Diamond RH (2006) Quality of life after proctocolectomy with ileoanal anastomosis for patients with ulcerative colitis. J Clin Gastroenterol 40:669–677
Olsen KO, Joelsson M, Laurberg S, Oresland T (1999) Fertility after ileal pouch-anal anastomosis in women with ulcerative colitis. Br J Surg 86:493–495
Mantzaris GJ, Archavlis E, Christoforidis P, et al (2001) A prospective randomized controlled trial of intravenous ciprofloxacin as an adjunct to corticosteroids in acute, severe ulcerative colitis. Scand J Gastroenterol 36:971–974
Dunckley P, Jewell D. Management of acute severe colitis. Best Pract Res Clin Gastroenterol 17:89–103 (2003).
Van Assche G, D’Haens G, Noman M, et al (2003) Randomized, double-blind comparison of 4 mg/kg versus 2 mg/kg intravenous cyclosporine in severe ulcerative colitis. Gastroenterology 125:1025–1031
Weber A, Fein F, Koch S, et al (2006) Treatment of ulcerative colitis refractory to steroid therapy by oral microemulsion cyclosporine (Neoral). Inflamm Bowel Dis 12:1131–1135
Moskovitz DN, Van Assche G, Maenhout B, et al (2006) Incidence of colectomy during long-term follow-up after cyclosporine-induced remission of severe ulcerative colitis. Clin Gastroenterol Hepatol 4:760–765
Jakobovits SL, Jewell DP, Travis SP (2007) Infliximab for the treatment of ulcerative colitis: outcomes in Oxford from 2000 to 2006. Aliment Pharmacol Ther 25:1055–1060
Lees C, Heys D, Ho GT et al (2007). A retrospective analysis of the efficacy and safety of infliximab as rescue therapy in acute severe ulcerative colitis. Aliment Pharmacol Ther 26:411–419
Reinisch, W. Van Assche G, Befrits R, et al (2012) Recommendations for the treatment of ulcerative colitis with infliximab: a gastroenterology expert group consensus. J Crohns Colitis 6:248–258
Laharie D, Bourreille A, Branche J, et al (2012) Ciclosporin versus infliximab in patients with severe ulcerative colitis refractory to intravenous steroids: a parallel, open-label randomised controlled trial. Lancet 380:1909–1915
Maser E, Deconda D, Lichtiger S, et al (2008) Cyclosporine and infliximab as rescue therapy for each other in patients with steroid-refractory ulcerative colitis. Clin. Gastroenterol. Hepatol. 6, 1112–1116
Author information
Authors and Affiliations
Corresponding authors
About this article
Cite this article
Soularue, E., Pariente, B. Prise en charge d’une colite aigüe grave. Colon Rectum 7, 18–26 (2013). https://doi.org/10.1007/s11725-013-0436-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11725-013-0436-4