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Early surgical intervention in ulcerative colitis
  1. M A Kamm
  1. Correspondence to:
    M A Kamm
    Department of Gastroenterology, St Mark’s Hospital, Watford Rd, Harrow HA1 3UJ, UK; kammic.ac.uk

https://doi.org/10.1136/gut.2003.001727

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    Medical treatment for both fulminant and chronic active colitis is now usually very effective. Given that surgical therapy is associated with substantial morbidity and mortality, the preferred treatment should be conservative.

    FULMINANT ULCERATIVE COLITIS

    Intravenous cyclosporin is of proven value in managing fulminant ulcerative colitis. In the definitive study of patients who failed intravenous steroid therapy, nine of 11 patients responded to cyclosporin compared with none of nine patients on placebo.1 Open clinical use has confirmed that colectomy can be avoided in the majority of patients.2–4 with short term response rates of up to 86%.4

    Cyclosporin can be continued even if there is mild colonic dilatation, provided the patient is clinically improving.4 Continued close observation by a gastroenterologist and a surgeon is essential.

    Criticism of cyclosporin has centred on drug toxicity, possible compromise of surgical outcome if drug therapy fails, and the possibility that successful drug therapy only delays inevitable surgery.

    The original trial dose of cyclosporin was 4 mg/kg/day intravenously,1 a dose associated with considerable morbidity. We5 and others6 have used a dose of 2 mg/kg/day, without …

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