New Diagnostic Criteria for Acute Severe Ulcerative Colitis in the Modern Treatment Era: A Modified Delphi Consensus by Refined Evaluation Framework and INvEstigations for Diagnostics in Acute Severe Ulcerative Colitis.

BACKGROUND & AIMS:Acute severe ulcerative colitis is a life-threatening manifestation of ulcerative colitis. The diagnosis typically relies on the 1955 Truelove and Witts criteria. These do not incorporate treatment history with steroids or modern advanced therapies. This Delphi panel gathered expert opinion regarding potential criteria and approaches for diagnosing acute severe ulcerative colitis in contemporary practice, including current outpatient treatment with corticosteroids or advanced therapy. METHODS:European, North American, and Asia-Pacific gastroenterologists participated in a 4-round Delphi panel and consensus meeting, forming the Refined Evaluation Framework and INvEstigations for Diagnostics in Acute Severe Ulcerative Colitis Working Group. Consensus was defined as ≥70% agreement/disagreement for Likert scale, or ≥70% homogeneity for single/multiple choice responses. RESULTS:Panelists agreed there is an unmet need for acute severe ulcerative colitis criteria in contemporary practice. Consensus was obtained that an acute severe ulcerative colitis diagnosis could be based around 3 'major' criteria (C-reactive protein ≥2× the upper limit of normal, ≥6 bowel movements in 24 hours, ≥50% bowel movements with visible blood in 24 hours) plus ≥2 'minor' criteria (low albumin, increased heart rate, nocturnal bowel movements, low hemoglobin, increased body temperature, or elevated leukocyte count) in patients treated with advanced therapy or corticosteroids. Patients on high-dose corticosteroids constitute a subgroup requiring different thresholds (C-reactive protein ≥1× upper limit of normal, ≥33% bowel movements with visible blood in 24 hours). Similar principles were agreed upon for untreated patients but without achieving consensus. Panelists agreed that endoscopy should confirm acute severe ulcerative colitis diagnosis and exclude cytomegalovirus infection and radiologic investigations should support excluding toxic megacolon. CONCLUSIONS:This consensus provides new diagnostic criteria for acute severe ulcerative colitis in the modern therapeutic era, which can be applied to patients already in receipt of outpatient treatments. These criteria include additional clinical and laboratory parameters for validation in prospective studies.