When is inpatient treatment indicated for inflammatory bowel disease (IBD)?

Updated: Oct 17, 2017
  • Author: William A Rowe, MD; Chief Editor: BS Anand, MD  more...
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Answer

Patients should be admitted to the hospital if surgical intervention is anticipated or if their condition does not respond to outpatient treatment, if they are dehydrated, or if they have uncontrolled pain or diarrhea. Start IV hydration. If indicated, obtain an abdominal flat-plate image to exclude obstruction or megacolon. If the patient is nauseous or vomiting or has evidence of obstruction or megacolon, nasogastric intubation may be helpful. Consider early consultation with a surgeon in the setting of severe colitis or bowel obstruction.

If the patient has active colitis, send a stool sample for Clostridium difficile toxin assay and routine microbiologic culture. Laboratory studies to be considered include a complete blood cell (CBC) count with differential; erythrocyte sedimentation rate; levels of albumin, glucose, calcium, magnesium, phosphate, and BUN/creatinine; electrolyte status; and a pregnancy test in females of childbearing age.

Patients with acute severe colitis are treated with IV corticosteroids. Antibiotics are not routinely used but may be indicated in select patients. Electrolyte correction and, potentially, blood transfusion can be administered if indicated on the basis of laboratory findings. The IBD Sydney Organisation and the Australian Inflammatory Bowel Diseases Consensus Working Group recommendations include the following for patients with acute severe ulcerative colitis [101] :

  • Hospitalization
  • Unprepared flexible sigmoidoscopy to assess severity and exclude cytomegalovirus colitis
  • Intravenous thromboembolism prophylaxis
  • IV hydrocortisone 100 mg tid/qid and close monitoring
  • If insufficient response by day 3, initiate rescue therapy with infliximab or cyclosporine
  • If no response by day 7 of rescue therapy or if clinical deterioration occurs, consider colectomy

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