Miguel Regueiro, MD, on Care for the Hospitalized Patient With Ulcerative Colitis

In this video, Dr Regueiro discusses managing the patient hospitalized with severe ulcerative colitis.

Miguel Regueiro, MD, is chair for Digestive Disease and Surgery Institute at Cleveland Clinic in Cleveland, Ohio.

TRANSCRIPT:

I'm Dr. Miguel Regueiro. I'm professor and chair of gastroenterology, hepatology, and nutrition at Cleveland Clinic in Cleveland, Ohio.

My presentation at AIBD 2021 involves the hospitalized patient with ulcerative colitis. This is a very important topic because we are seeing an increased prevalence of ulcerative colitis, but equally, we're seeing an increased rate of hospitalized ulcerative colitis patients.

Why is this? The answer is we don't entirely know; however, there seems to be a more severe presentation of ulcerative colitis than we have seen in the past, especially in our young male patients and young patients in general.

What this means is they come to the hospital requiring an admission. Why? Because they're bleeding. They have diarrhea. When we do a colonoscopy, they have very deep ulcers in the colon.

My talk will focus on how we manage them. When these patients are admitted, some are already taking corticosteroids like prednisone. One key aspect is while we do initiate intravenous steroids in the hospital, we want to be careful on the dose. Meaning, 60 milligrams of methylprednisolone a day is enough. That's number 1.

Number 2 is we need to act faster. What I mean by that is when they come to the hospital, we shouldn't wait a few days to do certain assessments. On day one or day two, we can do an unprepped —they don't need a prep because they're having so much diarrhea — sigmoidoscopy, or colonoscopy. That's number 2.

Number 3 is, if they have severe disease and they're on the IV steroids, we need to move to a next step. The 3 next steps today are infliximab, or cyclosporine, or surgery, which is a colectomy. We need to actually move along to that progression.

My talk will review the data on infliximab especially higher dose, 10 milligram per kilogram, accelerated. Meaning, we give a dose, and a few days later, we may give a second dose. Then, also discussion about cyclosporine and its utility in inpatient ulcerative colitis.

While for some, this may be a good agent to bridge them to another treatment like vedolizumab. Then, finally, we can't forget our surgical colleagues. Surgery is not a failure of disease. Sometimes, these patients do best with a colectomy given how severe they are.

In conclusion, I also will review the aspects of how blood clots in these patients are high, so we need to anticoagulate our patients, give low-dose molecular-weight heparin. These are important features as well.

With that review of how the patient presents and what we do initially to rule out certain infections and make sure that we understand the disease, to the different treatments like infliximab, cyclosporine, surgery, and newer treatments like tofacitinib, hyperbaric oxygen, to other complications like blood clots, that's really the essence of my talk.

I look forward to meeting and seeing all of you soon. Thank you very much.