BMJ  2006;333:501 (2 September), doi:10.1136/bmj.333.7566.501-b

Letter

Avoid delaying surgery in patients with severe ulcerative colitis

The first 150 words of the full text of this article appear below.

EDITOR—Collins and Rhodes, in their review of medical treatments for ulcerative colitis, cover surgical management options only very briefly, despite their acknowledgment that the overall colectomy rate is still about 25%.¹ Their comment that colectomy may be needed if medical treatment does not produce a substantial response within seven to 10 days cannot go unchallenged.

Fifteen per cent of patients with ulcerative colitis will have a severe attack, requiring admission to hospital, at some time during their illness. These patients are traditionally treated with intravenous corticosteroids, with a response rate of 60%; the remaining 40% require colectomy, which essentially cures the patient. Persisting with medical treatment if the response is inadequate is dangerous. If surgery is delayed the patient's general condition may deteriorate and lead to a risk of multiple organ dysfunction syndrome,² which may adversely affect the outcome.

Scoring systems for ulcerative colitis are useful in stratifying . . . [Full text of this article]

North Bristol NHS Trust drneilsmart@hotmail.com

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