Diagnostic and therapeutic features of acute severe colitis in Crohn's disease

Background: Acute severe colitis (ASC) is a life-threatening complication of inflammatory bowel disease, occurring less frequently in Crohn’s disease (CD) than in ulcerative colitis. Data on its clinical course and management in CD remain limited. Objective: To describe the diagnostic, therapeutic, and prognostic features of ASC complicating CD. Methods: We conducted a retrospective descriptive and analytical study including 46 CD patients hospitalized for ASC between January 2013 and January 2025 at Ibn Sina University Hospital, Rabat. Epidemiological, clinical, biological, endoscopic, therapeutic, and outcome data were collected Results: The mean age was 42.9 years (±15), with a female predominance (71.7%). ASC was inaugural in 43.5% of cases. Pancolitis (60.9%) and the inflammatory phenotype (76.1%) were the most frequent disease patterns. Abdominal pain (91.3%) and diarrhea (97.8%) were the predominant presenting symptoms. Endoscopy showed superficial ulcers in 84.8% and deep ulcers in 52.2%. All patients received intravenous corticosteroids; resistance was observed in 39.1%. Infliximab was used in 6.5% of cases, while surgery was required in 34.7%. During follow-up, clinical remission was achieved in 69.2%, mucosal healing in 61.5%, while mortality occurred in 4.3%. Conclusion: ASC in CD, although rare, represents a severe medical-surgical emergency with high corticosteroid resistance and surgical rates.