Definition - acute severe attacks of IBD
Severe acute ulcerative colitis is a life threatening condition characterized by:
- severe diarrhoea - > 6 stools per day with blood
- anaemia - Hb < 10 g/dL
- fever - > 37.5
- tachycardia - > 90 bpm
- raised ESR (and CRP) - ESR > 30mm per hour
- low albumin - < 30 g/L
This condition should be managed in hospital.
- mainstay of treatment is with IV steroids - such as methylprednisolone or hydrocortisone
- intravenous ciclosporin may be an option for patients intolerant to IV steroids
Colectomy is indicated in severe ulcerative colitis which fails to respond to medical therapy within 7 to 10 days.
Reference
- NICE. Ulcerative colitis: management. NICE guideline NG130. Published May 2019, reviewed February 2025
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