Abstract
BACKGROUND AND AIMS: Acute severe ulcerative colitis (ASUC) is a life-threatening manifestation of ulcerative colitis. Diagnosis typically relies on the 1955 Truelove and Witts criteria. These do not incorporate treatment history with steroids or modern advanced therapies. This Delphi panel gathered expert opinion regarding potential criteria and approaches for diagnosing ASUC in contemporary practice, including current outpatient treatment with corticosteroids/advanced therapy.
METHODS: European, North-American and Asia-Pacific gastroenterologists participated in a four-round Delphi panel and consensus meeting, forming the Refined Evaluation Framework and INvEstigations for Diagnostics in ASUC (REFINED-ASUC) Working Group. Consensus was defined as ≥70% agreement/disagreement for Likert-scale, or ≥70% homogeneity for single-/multiple-choice responses.
RESULTS: Panelists agreed there is unmet need for ASUC criteria in contemporary practice. Consensus was obtained that ASUC diagnosis could be based around 3 'major' (C-reactive protein (CRP) ≥2 x upper limit of normal (ULN), ≥6 bowel movements/24 hours, ≥50% bowel movements with visible blood/24 hours) plus ≥2 'minor' criteria (low albumin, increased heart rate, nocturnal bowel movements, low hemoglobin, increased body temperature, or elevated leukocyte count) in patients treated with advanced therapy/corticosteroids. Patients on high-dose corticosteroids constitute a subgroup requiring different thresholds (CRP ≥1 x ULN, ≥33% bowel movements with visible blood/24 hours). Similar principles were agreed for untreated patients but without achieving consensus. Panelists agreed endoscopy should confirm ASUC diagnosis and exclude cytomegalovirus infection, and radiologic investigations to support excluding toxic megacolon.
CONCLUSIONS: This consensus provides new diagnostic criteria for ASUC in the modern therapeutic era, that can be applied to patients already in receipt of outpatient treatments. These criteria include additional clinical and laboratory parameters, for validation in prospective studies.