Raymond Cross, MD: Define UC Disease Severity in Regard to Symptoms

Dr Cross reviews the highlights of his presentation on recommendations for initial diagnostics and treatment in the care of the hospitalized patient with ulcerative colitis.

Raymond Cross, MD, is professor of medicine and director of the IBD Program at the University of Maryland School of Medicine in Baltimore. He is also cohost of the IBD Drive Time podcast, cosponsored by AIBD and the Gastroenterology Learning Network. 

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TRANSCRIPT:

Hello, everyone. I'm Raymond Cross, professor of medicine at the University of Maryland School of Medicine. I just gave a presentation on management of the hospitalized patient with ulcerative colitis. As you know, these are some of our sicker patients that we treat in our practices, and I'm going to go over some highlights of my presentation, which hopefully make management of these patients a bit easier for you.

So we first talked about defining disease severity in regard to symptoms. We talked also a bit about some of the recommendations for initial diagnostics and treatment with emphasis on vigorous hydration of patients, making sure that we provide nutrition and not withhold nutrition in these patients. And we placed a great deal of emphasis on the importance of prophylaxis against deep venous thrombosis. We also talked about the optimal time that patients should be on intravenous steroids, which really should be 3 days and no more than 5 days before you decide whether you're going to transition a patient to oral prednisone and potential discharge or to an advanced therapy.

We also discussed some of the predictive models that will give you a sense of whether steroid therapy is going to be effective or ineffective approximately around day 2 or 3 of the hospitalization. I review the literature on use of advanced therapies such as infliximab, cyclosporine, and potentially some newer agents that we can use in a situation, the JAK-STAT inhibitors like tofacitinib or upadacitinib, as well as hyperbaric oxygen therapy, which is going to be studied in a randomized controlled trial across the United States shortly.

And then we also emphasized the importance of delays in referral to surgery and how that can impact not only morbidity, but also mortality for patients. And there was a study that I presented that highlighted that for every day after the fourth day of admission, mortality rates increase by 1.03 for an odds ratio. So for example, if your patient is hospitalized for 8 days, they now have a 12% increase in the risk of mortality, which is really sobering and highlights the need to get our excellent colorectal surgeons involved in the care of these patients early. So hopefully this was helpful and impacts your clinical practice.

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