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Ulcerative colitis acute: Management of acute severe ulcerative colitis (NICE CG 166)

Acute Severe Ulcerative Colitis: How Is It Treated?

Written by Jodi Helmer

  • What Is Acute Severe Ulcerative Colitis?
  • How Is Acute Severe Ulcerative Colitis Treated?
  • Who Is at Risk for Acute Severe Ulcerative Colitis?
  • What Are the Long-Term Outcomes for Acute Severe Ulcerative Colitis?

For the 907,000 Americans with ulcerative colitis, living with symptoms like urgent bowel movements, abdominal cramps, and loose or bloody stools can be overwhelming, but treatments can help keep symptoms in check.

Ulcerative colitis is a chronic disease, and most people have mild to moderate symptoms (called flares) that alternate with periods of remission. Between 10% and 20% of people with ulcerative colitis will have a more aggressive form of the disease called acute severe ulcerative colitis.

Acute severe ulcerative colitis (ASUC) is a serious complication of ulcerative colitis. It’s diagnosed when the disease flares and causes frequent bowel movements and bloody diarrhea, rapid heart rate, abdominal tenderness, fever, high levels of inflammation, and anemia. Inflammation in the intestinal wall makes the colon swollen and dilated, causing the stomach to become bloated. This is linked to a risk of developing toxic megacolon, the most serious complication of colitis.

ASUC is considered a medical emergency, and you’ll probably be hospitalized to help manage the disease. Without treatment, ASUC could be life-threatening.

ASUC is a challenging condition to treat. Once you’re admitted to the emergency room, you’ll get a series of tests, including blood tests, stool tests, and an exam of your bowel called a sigmoidoscopy. You’ll also get intravenous fluids to boost hydration.

The average hospital stay for ASUC treatment ranges from 4.6 to 12.5 days. During this time, your health care providers may include a gastroenterologist, colorectal surgeon, dietitian, pharmacist, and stomal therapist. The goal of hospitalizing you is to end the flare, get your symptoms under control, and put the disease into remission. Your doctors will want to make sure that rectal bleeding and diarrhea have stopped and normal bowel movements have returned. Rehospitalization is common.

Intravenous steroid medications are the most common treatment for ASUC. For 30% to 40% of ASUC patients, steroid treatments don’t work – and taking steroid medications for more than 10 days increases your risk of complications.

If the steroids don’t help within 3 to 5 days, your health care team will start “medical rescue therapy” with immunosuppressive drugs like cyclosporine or infliximab.

You might get an operation to remove part (or all) of your colon, called a colectomy, if your ASUC doesn’t respond to steroids, immunosuppressants, or other medical treatments.

Research shows that patients who were admitted to the hospital for ASUC with symptoms that included more than eight bowel movements per day and higher levels of inflammation in their blood had an 85% likelihood of needing surgery.

If you have complications like a perforation of the colon or toxic megacolon, surgery will be the first treatment. Delaying surgery could increase your risk of complications following the operation.

Researchers have explored whether medications called Janus kinase (JAK) inhibitors, which block certain enzymes that are overactive in ASUC, could help treat the disease and decrease the number of patients who needed colectomy surgery. The study showed promising results, and research is ongoing.

Most diagnoses of ulcerative colitis are in men between the ages of 15 and 35. The disease course for ASUC can be harder to predict, but it commonly appears between ages 34 and 48.

There is data showing that 54% of those who developed ASUC get it within 1 year of their UC diagnosis; 18% developed ASUC within 1 to 5 years of their initial diagnosis; and 28% were diagnosed with ASUC more than 5 years after their UC diagnosis.

Additional studies show that those who were diagnosed before the age of 40 had an aggressive disease course, had large or deep ulcers on their colons, higher levels of inflammation, were prescribed steroid medications earlier in their disease, and were at a higher risk of severe disease, including ASUC. Men were at higher risk of needing a colectomy than women.

The long-term outlook for ASUC is guarded. There is a 20% chance that you’ll need colectomy surgery after your first hospitalization, but that chance rises to 40% after two hospital admissions for ASUC. Severe flares are linked to a 1% risk of death.

Older age is linked with higher death rates. The death rate from ASUC is over 10% in people over 80 compared to fewer than 2% for people between the ages of 50 and 59.

UC is a chronic disease with no cure. Developing acute, severe symptoms is a risk for up to 20% of those diagnosed with the disease. With hospitalization, medical management, and a knowledgeable health care team, you can recover from a bout of ASUC and go into remission, but new flares are possible.

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Management of acute severe ulcerative colitis

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Ulcerative colitis – symptoms, causes, treatment

This ailment has recently become more common, and not only among the elderly, but also among young people. If earlier “the stomach” complained mainly of the townspeople, today the disease “captures” the rural areas as well. What are the reasons and how to deal with the situation?

Natalya Timchenko, doctor-gastroenterologist of OKDC, head of the Gastroenterological Diagnostics Center, Candidate of Medical Sciences, answers these questions.

– Natalya Alekseevna, it’s no secret that the effectiveness of any disease treatment directly depends on early detection and competent, timely diagnosis. What symptoms should alert a person and tell him that it is time to consult a specialist in order to detect an ailment at an early stage?

– The manifestations of ulcerative colitis and their severity vary greatly. In some patients, quite a decent state of health has been maintained for many years, and the disease manifests itself only with an admixture of blood in the stool. Such patients often associate this symptom with hemorrhoids, refuse a full examination and are addicted to self-medication. Others, on the contrary, from the very beginning of the development of ulcerative colitis are hospitalized with repeated bloody diarrhea, fecal incontinence, high fever, abdominal pain, palpitations and general weakness.

The most specific symptoms of ulcerative colitis are: blood, mucus and pus in the feces, diarrhea or vice versa, constipation, which often indicate an inflammatory lesion of the lower parts of the colon. Sometimes patients experience false urge to empty the bowels, nocturnal bowel movements, fecal incontinence, bloating and pain in the left side of the abdomen.

In severe and widespread inflammation, fever, vomiting, heart palpitations, weight loss, dehydration, loss of appetite appear. In 10% of cases, in addition to the mentioned intestinal and general symptoms, extraintestinal manifestations occur: articular lesions, various rashes on the skin and mucous membranes, for example, in the mouth, lesions of the liver and bile ducts; thrombus formation.

– The symptoms are, frankly, unpleasant. The question immediately arises – why did the disease arise and how to avoid it …

– Despite numerous scientific studies, all the causes of ulcerative colitis of the intestine have not yet been established. It has been suggested that the disease can be provoked by some unidentified infection, although ulcerative colitis is not contagious, or an unbalanced diet with a lack of fiber, genetic mutations, drugs – certain non-hormonal anti-inflammatory drugs, as well as stress and changes in the intestinal microflora. The trigger for ulcerative colitis can be dysbacteriosis; sedentary lifestyle; diet poor in dietary fiber and rich in carbohydrates; dysbacteriosis; neuropsychic overload.

– Is it possible to take some preventive measures in this case…

– Methods of prevention are well known. It is necessary to eat right, avoiding too fatty, spicy and salty foods, not to abuse alcohol, lead a mobile lifestyle, without exposing yourself to unnecessary stress, physical and mental overload. And at the slightest discomfort and pain, I recommend immediately contacting a competent specialist in order to establish an accurate diagnosis and develop an individual treatment strategy.

– What is included in the mandatory standard of gastroenterological examination today?

These are primarily instrumental types of examination. Gastroscopy and colonoscopy. Diagnostic gastroscopy and colonoscopy are performed in the OKDC using high-tech video information systems of the expert class “EVIS EXERA 2” and “EVIS EXERA 3” complete with video endoscopes with narrow-spectrum and magnification functions, as well as video archiving of the identified pathology.

The equipment of the endoscopic department of the OKDC allows to significantly expand the possibilities of diagnostics – to obtain an image of the smallest details, to identify and classify structural changes in the mucous membrane of internal organs, so as not to miss the tumor pathology.

Our specialists perform a wide range of endoscopic examinations and manipulations:

• video esophagogastroduodenoscopy (VGDS) – assessment of the condition of the mucous membrane of the esophagus, stomach and duodenum;

• videocolonoscopy (VCS) – assessment of the condition of the colon mucosa;

Serious attention is paid to the morphological diagnosis of detected endoscopic pathology. In almost 100% of studies, a mucosal biopsy is performed for cytological and histological studies, and express tests are carried out.

Endoscopic tissue biopsy for gastrointestinal examinations is usually taken from any suspicious site. This is the standard that allows you to identify early gastrointestinal cancer and treat it successfully. If cell degeneration is detected at the very beginning, then their early endoscopic removal without surgery is possible.

– Is it possible to cope with the disease without surgery?

In the treatment of ulcerative colitis, both conservative and surgical methods are used, the choice depends on the patient’s condition and the nature of the course of the disease.

Drug treatment of ulcerative colitis is based on the use of anti-inflammatory, nonsteroidal drugs. In addition, patients are shown the use of symptomatic painkillers, physiotherapy: interference therapy, diadynamic therapy.

After the period of exacerbation of the disease has passed, the patient must take anti-inflammatory drugs for another six months. Then a follow-up colonoscopy is performed. If there are no inflammatory processes on the colonic mucosa, then the treatment process is completed.

Diet is important in the treatment of ulcerative colitis. If the disease is severe, then during its exacerbation, the patient is recommended to completely refuse food and drink only water.

An ulcerative colitis diet during an exacerbation is needed to reduce irritation of the intestinal mucosa and to stop diarrhea. Foods that contain fiber and dietary fiber, as well as sour and spicy foods, coarse foods, and alcoholic beverages should be excluded from the diet. Since the inflammatory process in the large intestine leads to depletion of the body, the diet for ulcerative colitis outside the period of exacerbation involves the use of high-calorie, protein-rich and vitamin-rich foods. You need to eat at least six times a day in small portions.

Spices, sauces, fried and fatty foods, raw vegetables and fruits are excluded from the diet. Be careful with dairy products. Allowed: fish, lean meat (turkey, beef, rabbit, chicken) in boiled and baked form, cereals, soups on low-fat fish and meat broth, eggs, rice, potatoes, jelly, jelly from various fruits and berries, dried bread, cottage cheese souffle. You can drink black coffee, tea, cocoa on the water, decoctions of bird cherry, wild rose, blueberries. And only in cases of ineffective conservative treatment, surgical intervention is used.

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Ulcerative colitis / Diseases / Clinic EXPERT

Ulcerative colitis is a severe chronic disease characterized by erosive and ulcerative lesions of the colon mucosa, progressive course and frequent development of complications (bleeding, perforation, narrowing of the lumen, etc. ). The second name of this disease is non-specific ulcerative colitis (NUC).

Clinical trial of patients with bowel disease is being recruited

Clinic EXPERT invites you to participate in a long-term phase II study to evaluate the efficacy and safety of the drug in patients with moderate or severe inflammatory bowel disease.

More details

Membership: 58 weeks.

We welcome patients aged 18 to 65 with:

  • Crohn’s disease
  • ulcerative colitis.

In order to participate in clinical trials, a patient must meet the criteria set by the drug company. If you are interested in this study, sign up for an initial paid evaluation consultation with a gastroenterologist Kharitonov A.G. or to the gastroenterologist Sokolova K.S. to determine if you can participate. Participants in the study are guaranteed free examinations, specialist consultations and treatment with drugs from the pharmaceutical company.

You can contact us by phone 8 (812) 426-35-35:

  • Mon-Sat: from 09-00 to 21-00
  • Sun: from 09-00 to 16-00.

The causes and origin of ulcerative colitis of the intestine have not yet been determined, despite the study and research on this topic.


The symptoms characteristic of ulcerative colitis can be divided into three groups:

  • general
  • intestinal
  • extraintestinal

General symptoms

These are manifestations of the disease on the part of the whole organism as a whole, are not specific for ulcerative colitis and occur in many diseases: cervical symptoms

These are various disorders in bowel function, such as:

  • diarrhea
  • in rare cases – constipation
  • blood and mucus in the stool
  • “false” urges, imperative (urgent) urge to defecate
  • pain in the abdomen (more often pain occurs in the left iliac region, but can spread throughout the abdomen)
  • bloating, rumbling of the abdomen.

If these symptoms appear, it is recommended to be tested to rule out ulcerative colitis.

Extraintestinal manifestations of the disease

The disease has manifestations from other organs, which may appear before symptoms from the intestines.

These are changes from outside:

  • skin (rashes, pustules on the skin)
  • oral cavity (sores in the oral cavity)
  • eyes (pain, pain in the eyes, redness of the eyes, lacrimation and photophobia, decreased vision, discoloration of the iris)
  • joint damage ( pain, swelling, redness, stiffness of the joints)
  • damage to the liver and biliary tract (yellowing, itching of the skin)
  • other conditions (anemia, including iron deficiency, malnutrition).

Exacerbations of ulcerative colitis are manifested by frequent stools, increased body temperature and laboratory parameters (ESR, C-reactive protein).

The following degrees of severity of exacerbation are distinguished:


  • stools with blood less than 4 times a day
  • pulse, temperature, hemoglobin and ESR are normal.


  • stools with blood more than 4 but less than 6 times a day
  • pulse not more than 90 bpm less 105 g/l
  • ESR above normal, not higher than 30 mm/h


  • stool with blood more than 6 times a day
  • pulse more than 90 bpm
  • body temperature more than 37.5 C
  • hemoglobin less than 105 g/l
  • ESR more than 30 mm /hour.

Mild to severe attacks can be treated in outpatient/day hospital settings. With a severe attack, hospitalization is necessary.

In severe forms, patients are recommended to undergo mandatory examination and treatment in a hospital, since any diagnostic, therapeutic procedures and interventions can have serious complications with a risk of death.

With any severity of the disease, you should immediately contact a gastroenterologist for help, as a mild attack can worsen to severe at any time, which is a life-threatening situation.


The EXPERT Clinic has developed a clear algorithm for diagnosing ulcerative colitis. Necessary comprehensive examination includes:

Laboratory methods

  • The infectious nature of the disease is excluded: the patient’s feces and blood are examined for bacteria, viruses, protozoa and fungi.
  • clinical, biochemical blood tests, coprogram
  • immunological screening for inflammatory bowel diseases (blood for ASCA, pANCA)
  • feces for calprotectin (reflects the presence of inflammation in the intestine)

Instrumental studies

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  • Abdominal ultrasound . Indirect signs of inflammation of the intestinal wall are evaluated, as well as changes in other organs of the gastrointestinal tract to exclude complications of the disease, as well as concomitant pathology).
  • Sigmoidoscopy with biopsy. It is very important to assess the condition of the mucosal surface, as well as to perform a biopsy with further examination of a piece of mucosa by a morphologist.
  • FGDS. Imaging of the esophagus, stomach, and duodenum is necessary to exclude signs of Crohn’s disease in them, since this disease is always a differential diagnosis for suspected ulcerative colitis.
  • Colonoscopy with biopsy. It is a very important study. This is a rather complicated research method that carries certain risks, so the doctor should determine the indications for its implementation, and a highly qualified specialist should perform it.
  • Colon View test. Diagnoses the risks of a tumor in the intestine in patients with long-term ulcerative colitis.
  • Important! The volume of the necessary examination can only be determined by a gastroenterologist.


    Ulcerative colitis is a fairly serious disease that can progress (abruptly or gradually) /. Some patients initially have resistance to the drugs used or it develops during treatment, and life-threatening complications are possible.

    Depending on the specific clinical situation, the following are used in the treatment:

    • preparations containing 5-acetylsalicylic acid. Both in the form of tablets, granules or capsules, and in the form of dosage forms for administration into the rectum (suppositories, ready-made enemas or foams)
    • corticosteroids in the form of tablets, regular or rectal (introduced through the anus), infusions
    • immunosuppressants
    • biological therapies.

    All types of drug therapy must be prescribed and monitored by a gastroenterologist, because:

    • these drugs have serious side effects on other organs and systems
    • some patients have initial resistance or gradually develop resistance to drugs

    EXPERT Clinic adheres to the principle of stages in treatment.

    At the first stage, a treatment plan is drawn up, which includes:

    • regimen
    • diet
    • selection of basic therapy with 5-aminosalicylic acid preparations
    • if necessary – antibacterial drugs, pre- and probiotics, since exacerbation of ulcerative colitis in most cases is accompanied by severe intestinal dysbiosis

    At the second stage, the effectiveness of the therapy is evaluated:

    • clinical symptoms become less pronounced, then the regimen and diet expand, a date for a second visit to the doctor is set.
    • If there is no improvement in well-being during the therapy, the issue of prescribing stronger drugs (systemic and local glucocorticoids, cytostatics, biological therapy) is decided. However, it should be noted that in case of a very severe course of the process, these drugs can be prescribed immediately, at the first stage of treatment.

    The third stage of treatment is carried out after achieving a stable remission.

    It is a scheme to gradually reduce the doses of prescribed drugs to maintenance.

    Even after achieving the long-awaited remission, the patient is advised to be attentive to himself and regularly see a gastroenterologist, as the risk of disease recurrence is high.

    Virtually all patients need to take their doctor’s recommended anti-relapse medication. Some drugs help reduce the risk of developing colon cancer.


    Ulcerative colitis is a severe chronic disease that worsens over time without adequate treatment, symptoms become more pronounced, exacerbations are longer and more frequent, and there is a high probability of complications (rupture of the intestinal wall, intestinal bleeding).

    Patients with ulcerative colitis have a significantly increased risk of developing bowel cancer. In this regard, long-term maintenance treatment is often prescribed.

    At the moment, it is impossible to cure ulcerative colitis with the help of drugs, however, properly selected therapy in most cases allows achieving a stable and long-term remission of the disease.

    If you have any of the symptoms listed above (abdominal pain, diarrhea, blood or mucus in your stool), you should seek immediate medical attention.

    Remember that it is very important to start treatment in the early stages of the disease, as in advanced cases, as a rule, long-term, difficult and expensive therapy is required.


    To prevent the development of the disease, as well as relapse, it is necessary to adhere to a correct, balanced and regular diet – avoid fast food, canned, flavored foods, fried, smoked; It is recommended to eat at the same time. It is important to protect yourself from stressful situations.

    During the period of exacerbation, patients are recommended a sparing diet that meets the following requirements:

    • elimination of coarse fiber (raw vegetables, berries, fruits, nuts, seeds, poppy, sesame, bran, legumes, etc.)
    • foods are steamed or boiled
    • warm foods are rubbed or (for constipation) boiled vegetables are grated on a coarse grater
    • chemical irritants of the intestinal mucosa are excluded (spicy, salty, pickled, sour foods)
    • high-protein foods are recommended (lean meat, turkey, low-fat river fish, egg white, soy products, cottage cheese, etc.)
    • special therapeutic food mixtures sold in pharmacies (Modulen, etc.).

    In order to prevent relapses, all patients are recommended to consult a gastroenterologist once a quarter for the necessary correction of drug therapy.

    Frequently asked questions

    Can ulcerative colitis be cured?

    Ulcerative colitis is a chronic autoimmune disease. The body produces antibodies against the mucosa of its own colon, as a result of which the mucosa is damaged. What causes the production of these antibodies is still not known. Without knowing the cause, it is impossible to find a cure for it.

    Thus, the available drugs are aimed at reducing the intensity of the inflammatory process, allow achieving remission, but cannot completely cure the disease.

    The only possible cure is surgical treatment (removal of the colon). Indications for surgical treatment of ulcerative colitis are the low effectiveness of conservative therapy or the impossibility of its continuation, intestinal complications of ulcerative colitis (toxic dilatation, intestinal perforation, intestinal bleeding), as well as colon cancer or a high risk of its occurrence.

    What causes disease?

    For what reasons this disease develops is still not exactly known.

    A significantly higher incidence of ulcerative colitis among the urban population, in contrast to the rural population, has been established. It is assumed that genetic predisposition and environmental factors (ecology, malnutrition, stress) play a role in the occurrence of the disease.

    Is the disease a contraindication to pregnancy?

    Ulcerative colitis is not a contraindication to pregnancy, however, before planning it, it is important to achieve a stable remission of the disease, it is necessary to conduct a series of examinations, as well as select medications that can be used during pregnancy.

    Can ulcerative colitis present with constipation?

    Ulcerative colitis may present with constipation due to rectal spasm due to inflammation. It is recommended to undergo a complete examination to exclude this pathology.

    Is there an increased risk of getting ulcerative colitis if a close relative has the disease?

    Having a relative’s ulcerative colitis increases your risk of having the disease.

    Treatment histories

    Case №1

    Patient N., 23 years old, turned to the gastroenterologist of the EXPERT Clinic with complaints of pain in the lower abdomen before defecation, mushy stools up to 4-5 times a day with an admixture of scarlet blood, general weakness .

    At the beginning of her illness, when the patient noticed blood in the stool, she tried to treat herself, assuming that it was hemorrhoids, but without effect. Over time, the situation worsened, and the state of health worsened: general weakness increased, the number of bowel movements increased to 5-6 per day, the pain intensified. She called an ambulance several times, underwent rectoscopy and colonoscopy. According to the results of the research, the mucosa of the rectum, sigmoid colon is inflamed, bleeding, with multiple erosions. The patient was prescribed a course of anti-inflammatory drugs. The state of health remained the same, the girl began to notice an increase in body temperature up to 37.2 C, lost weight by 9kg.

    In the EXPERT Clinic, the examination was carried out in stages: a thorough examination of the skin, tongue, measurement of temperature, height, weight, palpation of the abdominal cavity. Then – general clinical tests, the results of which revealed iron deficiency anemia, in the coprogram – a large amount of mucus and erythrocytes. The doctor ruled out an infectious process: no harmful bacteria were found in the feces. The patient underwent rectoscopy, FGDS, abdominal ultrasound. Based on the results of the entire examination, a diagnosis of ulcerative colitis, acute course, and intestinal dysbacteriosis was made. The doctor also noted HP-associated superficial gastritis, and the first stage of gallstone disease.

    The patient consulted an experienced nutritionist: given the severity of the inflammation, she was explained the diet, indicated the permitted and prohibited foods and how to prepare them. The gastroenterologist prescribed drugs to restore the mucous membrane of the stomach and intestines, normalize the outflow of bile, iron preparations to eliminate anemia. Given the presence of intestinal dysbacteriosis with the growth of opportunistic flora, a course of intestinal antibiotics and probiotics was prescribed.

    After a week of treatment and diet, the patient’s condition improved, and after two months all symptoms gradually disappeared.