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Definition - acute severe attacks of IBD

Authoring team

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

  1. NICE. Ulcerative colitis: management. NICE guideline NG130. Published May 2019, reviewed February 2025

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