Clinical Report: Management of Acute Severe Ulcerative Colitis and its Socioeconomic Impact

Patient Presentation and Initial Diagnosis

A case report was reviewed concerning a 35-year-old female hospital administrator and primary caregiver for two young children, presenting with an acute exacerbation of a 7-year history of ulcerative colitis (UC). The patient’s condition demonstrates the profound impact of non-communicable diseases (NCDs) on individuals during their most productive years, directly challenging the achievement of SDG 3 (Good Health and Well-being) and SDG 8 (Decent Work and Economic Growth).

• Presenting Condition: Acute abdominal pain, distension, and severe bloody diarrhea despite ongoing maintenance therapy.
• Clinical Findings: The patient was febrile, tachycardic, and hypotensive, with significant laboratory abnormalities indicating severe inflammation and anemia.
• Socioeconomic Impact: The patient reported significant difficulty managing her professional and family duties, highlighting how chronic illness can impede economic participation and place a heavy burden on women, who often serve as primary caregivers, linking the health crisis to SDG 5 (Gender Equality).
• Diagnosis: The clinical and radiological findings were consistent with toxic megacolon, a life-threatening complication of UC. This underscores the necessity for robust healthcare systems capable of providing urgent and specialized care, a core target of SDG 3.

Therapeutic Interventions and Outcomes

Medical and Surgical Management Pathway

The patient’s management pathway illustrates the complexity of care required for severe NCDs and highlights potential inequalities in healthcare access, a key concern of SDG 10 (Reduced Inequalities). The high cost and resource intensity of such care also pose risks related to SDG 1 (No Poverty), as catastrophic health expenditures can impact family financial stability.

1. Initial Medical Management: The patient was admitted and treated with intravenous corticosteroids, bowel rest, and supportive care.
2. Failure of Medical Therapy: A lack of clinical improvement after 72 hours necessitated a re-evaluation of the treatment strategy, indicating the limitations of medical therapy in fulminant colitis.
3. Surgical Intervention: Urgent surgical consultation was sought, leading to a subtotal colectomy with end ileostomy. This life-saving intervention is a cornerstone of managing medically refractory severe UC, but its availability is a marker of an advanced healthcare system, pointing to global disparities addressed by SDG 10.
4. Postoperative Complications: The patient later developed pelvic sepsis and inflammation of the retained rectal stump, requiring further medical management.
5. Restorative Surgery Planning: Following recovery, the patient was considered for a restorative ileal pouch-anal anastomosis (IPAA), a procedure aimed at improving long-term quality of life, which is central to the well-being aspect of SDG 3.

Analysis through the Lens of Sustainable Development Goals (SDGs)

SDG 3: Good Health and Well-being

This case is a clear illustration of the challenges in managing NCDs. Achieving SDG 3 requires health systems that can not only prevent disease but also manage complex, chronic conditions and their acute, life-threatening complications.

• Access to Essential Services: The patient’s survival depended on access to emergency care, advanced diagnostics, intensive medical therapy, and specialized surgery.
• Quality of Life: The ultimate goal of restorative surgery (IPAA) is to improve long-term functional outcomes and quality of life, aligning with the SDG 3 target of promoting well-being for all.
• NCD Management: The case highlights the need for integrated care pathways for NCDs, from maintenance therapy to emergency intervention and long-term surgical solutions.

SDG 5 (Gender Equality) & SDG 8 (Decent Work and Economic Growth)

The patient’s identity as a working mother underscores the intersection of health, gender, and economic stability.

• Impact on Women: The debilitating illness directly threatened the patient’s ability to function as a professional and a primary caregiver, roles critical to family and societal well-being. Ensuring women’s health is fundamental to achieving SDG 5.
• Economic Productivity: Chronic and acute illness episodes disrupt employment and productivity. By providing effective healthcare that allows individuals to return to work, health systems contribute directly to SDG 8.

SDG 10: Reduced Inequalities

The sophisticated level of care received by the patient is not universally accessible. This case highlights the significant disparities in healthcare capabilities that SDG 10 aims to address.

• Healthcare Equity: Access to biologic therapies, emergency colectomy, and multi-stage reconstructive surgery represents a high standard of care. Global, national, and sub-national inequalities mean that outcomes for a patient with the same condition could be vastly different elsewhere.
• Financial Barriers: The cost of such comprehensive treatment can be prohibitive, creating a barrier to care and exacerbating inequalities. Universal health coverage is a key mechanism for mitigating these financial risks and ensuring equitable access for all, preventing descents into poverty (SDG 1).

1. Which SDGs are addressed or connected to the issues highlighted in the article?

SDG 3: Good Health and Well-being

• The entire article is a clinical case study focusing on the diagnosis and treatment of a severe complication of a chronic non-communicable disease (ulcerative colitis). It details the patient’s health crisis, access to emergency care, advanced medical therapies, and complex surgical interventions, all of which are central to ensuring healthy lives and promoting well-being.

SDG 5: Gender Equality

• The article specifies that the patient is a woman who is the “primary caregiver for two children under 5 years of age.” It highlights that her illness creates “increasing difficulty managing her professional and family responsibilities,” touching upon the disproportionate burden of unpaid care and domestic work often placed on women, which is a key concern of SDG 5.

SDG 8: Decent Work and Economic Growth

• The patient’s chronic illness directly impacts her professional life. The article notes her “increasing difficulty managing her professional… responsibilities” as a hospital administrator. This connects to the goal of achieving full and productive employment, as chronic health conditions can be a significant barrier to maintaining consistent and effective work.

2. What specific targets under those SDGs can be identified based on the article’s content?

SDG 3: Good Health and Well-being

• Target 3.4: “By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.” The article is a clear example of the “treatment” aspect of this target. It describes the management of ulcerative colitis, a non-communicable disease, and the urgent interventions required to prevent mortality from its complication, toxic megacolon, where delays increase the “risk of colonic perforation, sepsis, and death.”
• Target 3.8: “Achieve universal health coverage, including… access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.” The patient’s journey demonstrates access to a comprehensive range of quality health services, including emergency department care, laboratory and imaging diagnostics (CT scan), specialized pharmaceuticals (IL-23 antagonist, intravenous corticosteroids), and advanced surgical procedures (subtotal colectomy, IPAA reconstruction).

SDG 5: Gender Equality

• Target 5.4: “Recognize and value unpaid care and domestic work through the provision of public services, infrastructure and social protection policies and the promotion of shared responsibility…” The article highlights the challenge the patient faces as the “primary caregiver for two children,” illustrating the burden of unpaid care work, which is exacerbated by her severe health condition. Her difficulty in managing these responsibilities points to the need for support systems addressed by this target.

SDG 8: Decent Work and Economic Growth

• Target 8.5: “By 2030, achieve full and productive employment and decent work for all women and men… and persons with disabilities…” The patient’s struggle to manage her professional duties due to her illness relates to this target. Chronic diseases can act as a form of disability, impacting a person’s ability to achieve full and productive employment.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Indicators for SDG 3 Targets

• For Target 3.4 (Indicator 3.4.1: Mortality rate attributed to… chronic… disease): The article implies this indicator by focusing on life-saving interventions. The narrative revolves around preventing death from sepsis and colonic perforation, which are direct consequences of the patient’s chronic disease. The successful surgical outcome represents a positive data point against this mortality indicator.
• For Target 3.8 (Indicator 3.8.1: Coverage of essential health services): The article provides a qualitative list of services the patient received, which serves as an example of service coverage. This includes:
  • Emergency care admission
  • Access to specialists (colorectal surgery team)
  • Access to advanced drug therapies (IL-23 antagonist)
  • In-patient hospital care (bowel rest, intravenous corticosteroids)
  • Advanced surgical interventions (subtotal colectomy with end ileostomy, potential for IPAA)
  • Diagnostic services (laboratory evaluation, CT scans)

Indicator for SDG 5 Target

• For Target 5.4 (Indicator 5.4.1: Proportion of time spent on unpaid domestic and care work): While not providing a quantitative measure, the article implies this indicator by describing the patient as the “primary caregiver for two children under 5” and noting her “increasing difficulty managing her… family responsibilities.” This qualitative description points to a significant and burdensome amount of time spent on unpaid care work.

Indicator for SDG 8 Target

• For Target 8.5: The article implies an impact on labor productivity. The statement about her “increasing difficulty managing her professional… responsibilities” due to her UC flares serves as a qualitative indicator of reduced productivity and challenges in maintaining full employment, which could be measured by metrics like absenteeism or presenteeism (working while sick).

4. Table of SDGs, Targets, and Indicators

Source: reference.medscape.com