Scholarlink

<p>Since the prevalence of older patients with ulcerative colitis is increasing, hospitalizations for severe disease in this age group are expected to rise. Older patients are more likely to present with comorbidities and, consequently, frailty, the latter being one of the major drivers of worse outcomes. The conventional sequencing of therapies in acute severe ulcerative colitis—i.e., intravenous steroids followed, in case of refractoriness, by antitumor necrosis factor (TNF) agents, ciclosporin A, or Janus kinase inhibitors such as tofacitinib or upadacitinib—may frequently be contraindicated in older patients or may carry an increased risk of severe adverse events beyond infections. In the absence of specific guidelines, the implementation of and strict adherence to a structured, time-bound decision tree is essential in order to avoid unnecessarily prolonged treatment with systemic steroids in frail patients, which may lead to deleterious outcomes, particularly in those requiring surgery. Recent reports on adjunctive measures, such as hyperbaric oxygen therapy or total enteral nutrition, may also be considered given their encouraging safety profile.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Managing Acute Severe Ulcerative Colitis in the Older Patient: A Growing Concern

  • 期刊论文

  • 发表日期：

    2026年3月26日

查看全文
  • Walter Fries,
  • Giuseppe Costantino,
  • Anna Viola

摘要

Since the prevalence of older patients with ulcerative colitis is increasing, hospitalizations for severe disease in this age group are expected to rise. Older patients are more likely to present with comorbidities and, consequently, frailty, the latter being one of the major drivers of worse outcomes. The conventional sequencing of therapies in acute severe ulcerative colitis—i.e., intravenous steroids followed, in case of refractoriness, by antitumor necrosis factor (TNF) agents, ciclosporin A, or Janus kinase inhibitors such as tofacitinib or upadacitinib—may frequently be contraindicated in older patients or may carry an increased risk of severe adverse events beyond infections. In the absence of specific guidelines, the implementation of and strict adherence to a structured, time-bound decision tree is essential in order to avoid unnecessarily prolonged treatment with systemic steroids in frail patients, which may lead to deleterious outcomes, particularly in those requiring surgery. Recent reports on adjunctive measures, such as hyperbaric oxygen therapy or total enteral nutrition, may also be considered given their encouraging safety profile.