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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Ulcerative colitis – NHS

Ulcerative colitis is a long-term condition where the colon and rectum become inflamed.

The colon is the large intestine (bowel) and the rectum is the end of the bowel where poo is stored.

Small ulcers can develop on the colon’s lining, and can bleed and produce pus.

Symptoms of ulcerative colitis

The main symptoms of ulcerative colitis are:

• recurring diarrhoea, which may contain blood, mucus or pus
• tummy pain
• needing to poo frequently

You may also experience extreme tiredness (fatigue), loss of appetite and weight loss.

The severity of the symptoms varies, depending on how much of the rectum and colon is inflamed and how severe the inflammation is.

For some people, the condition has a significant impact on their everyday lives.

Symptoms of a flare-up

Some people may go for weeks or months with very mild symptoms, or none at all (remission), followed by periods where the symptoms are particularly troublesome (flare-ups or relapses).

During a flare-up, some people with ulcerative colitis also experience symptoms elsewhere in their body; which are known as extra-intestinal symptoms.

These can include:

• painful and swollen joints (arthritis)
• mouth ulcers
• swollen fat under the skin causing bumps and patches – this is known as erythema nodosum
• irritated and red eyes
• problems with bones, such as osteoporosis

In many people, no specific trigger for flare-ups is identified, although a gut infection can occasionally be the cause.

Stress is also thought to be a potential factor.

When to get medical advice

You should see a GP as soon as possible if you have symptoms of ulcerative colitis and you have not been diagnosed with the condition.

They can arrange blood or poo sample tests to help determine what may be causing your symptoms.

If necessary, they can refer you to hospital for further tests.

Find out more about diagnosing ulcerative colitis

If you have been diagnosed with ulcerative colitis and think you may be having a severe flare-up, contact a GP or your care team for advice.

You may need to be urgently admitted to hospital for immediate care.

If you cannot contact your GP or care team, call NHS 111 or contact your local out-of-hours service.

What causes ulcerative colitis?

Ulcerative colitis is thought to be an autoimmune condition.

This means the immune system, the body’s defence against infection, goes wrong and attacks healthy tissue.

The most popular theory is that the immune system mistakes harmless bacteria inside the colon as a threat and attacks the tissues of the colon, causing it to become inflamed.

Exactly what causes the immune system to behave in this way is unclear.

Many experts think it’s a combination of genetic and environmental factors.

Who’s affected

The UK Crohn’s & Colitis UK charity reports at least 1 in every 227 people in the UK has been diagnosed with ulcerative colitis. This amounts to around 296,000 people.

The condition can develop at any age, but is most often diagnosed in people between 15 and 25 years old.

It’s more common in white people of European descent, especially those descended from Ashkenazi Jewish communities, and black people.

The condition is rarer in people from Asian backgrounds, although the reasons for this are unclear.

Both men and women seem to be equally affected by ulcerative colitis.

How ulcerative colitis is treated

Treatment for ulcerative colitis aims to relieve symptoms during a flare-up and prevent symptoms from returning (maintaining remission).

In most people, this is achieved by taking medicine, such as:

• aminosalicylates (ASAs)
• corticosteroids (steroid medicines)
• immunosuppressants

Mild to moderate flare-ups can usually be treated at home. But more severe flare-ups need to be treated in hospital.

If medicines are not effective at controlling your symptoms or your quality of life is significantly affected by your condition, surgery to remove some or all of your bowel (colon) may be an option.

During surgery, your small intestine can be diverted out of an opening in your abdomen known as a stoma. This type of surgery is known as an ileostomy.

In some cases, the stoma is only temporary and can be closed up once your bowel has healed.

An alternative option is to create an internal pouch that’s connected to your anus called an ileoanal pouch.

Read more about treating ulcerative colitis

Complications of ulcerative colitis

Complications of ulcerative colitis include:

• an increased risk of developing bowel cancer
• poor growth and development in children and young people

Also, the steroid medicines used to treat ulcerative colitis can cause weakening of the bones (osteoporosis) as a side effect.

Read more about the complications of ulcerative colitis

IBD or IBS?

Inflammatory bowel disease (IBD) is a term mainly used to describe 2 conditions that cause inflammation of the gut (gastrointestinal tract).

They are:

• ulcerative colitis
• Crohn’s disease

IBD should not be confused with irritable bowel syndrome (IBS), which is a different condition and requires different treatment.

Information:

Social care and support guide

If you:

• need help with day-to-day living because of illness or disability
• care for someone regularly because they’re ill, elderly or disabled (including family members)

Our guide to care and support explains your options and where you can get support.

Page last reviewed: 01 November 2022
Next review due: 01 November 2025

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 biopsy of the mucosa is performed for cytological and histological studies, and express tests are carried out.

Endoscopic tissue biopsy for gastrointestinal studies 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, curd soufflé. 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 (UC) – symptoms, causes, types, diagnosis and prevention and treatment methods in the “SM-Clinic”

This disease is treated by Gastroenterologist
, Proctologist

• What is it?
• About disease
• Types of ulcerative colitis
• Symptoms of ulcerative colitis
• Causes of ulcerative colitis
• Diagnosis of ulcerative colitis
• Expert opinion
• Treatment of ulcerative colitis
• Surgical treatment
• Prevention of ulcerative colitis
• Rehabilitation
• Q&A

About the disease

Most often, UC occurs in the developed countries of Europe and North America. The prevalence of the disease in Russia is 20-30 cases per 100,000 population. Most often, the pathology occurs in men and women aged 20 to 42 years, as well as in the elderly.

Two most dangerous periods of development can be distinguished in ulcerative colitis:

• the first year; at this time, the likelihood of developing life-threatening complications is high;
• tenth year; at this point, the likelihood of developing malignant neoplasms increases.

Types of ulcerative colitis

In 2006, the European consensus on the diagnosis and treatment of ulcerative colitis identified 3 forms of the disease according to the degree of its prevalence:

• proctitis – inflammatory process occurs only in the rectum and is limited by the rectosigmoid angle;
• left-sided colitis – inflammation reaches the splenic flexure of the colon;
• widespread colitis – complete damage to the large intestine.

Depending on the severity of the pathology, three degrees are distinguished:

• mild;
• medium;
• heavy.

Classification of ulcerative colitis according to the nature of development and course:

• acute: less than six months have passed since the first manifestation of the disease;
• fulminant (rapidly developing) course;
• chronic continuous course: with adequate treatment, periods of remission are less than six months;
• chronic relapsing course: periods of remission last more than six months.

In the recurrent course of the disease, rarely recurrent (less than once a year) and often recurrent (2 times a year or more) are distinguished. Exacerbations of ulcerative colitis usually occur as a result of malnutrition, stress, or taking certain medications, but they can also occur without an obvious reason.

Symptoms of ulcerative colitis

Nonspecific ulcerative colitis is characterized by a cyclic course: periods of remission alternate with exacerbations. During remissions, there are usually no signs of UC, while exacerbations are characterized by various manifestations that vary depending on the location of inflammation and the intensity of the course of the disease.

The main symptoms of proctitis are:

• pain in the lower abdomen;
• bloody discharge from the anus;
• painful urge to empty the bowels.

Signs of left-sided ulcerative colitis with damage to the descending colon are:

• diarrhea with bloody impurities;
• weight loss;
• pronounced pain in the left side of the abdomen.

Widespread ulcerative colitis with total involvement of the large intestine is characterized by:

• persistent abdominal pain;
• persistent profuse diarrhea with bleeding.

In the latter case, the patient’s life is threatened by severe dehydration and blood loss.

It is also noted that sometimes people with ulcerative colitis may experience non-intestinal symptoms:

• stomatitis;
• vascular inflammation;
• diseases of the joints;
• dermatological pathologies;
• diseases of the biliary tract;
• bone softening or osteoporosis;
• ocular inflammatory diseases.

Causes of ulcerative colitis

At the moment, the causes of the disease remain unclear. It is statistically determined that ulcerative colitis of the intestine is more often diagnosed in people whose relatives had this pathology, and therefore the main cause is considered to be a genetic predisposition. The key to the development of ulcerative colitis is thought to be an imbalance in the immune system. The pathogenic microorganism provokes an immune response, due to which an inflammatory process develops that affects the intestinal mucosa and leads to ulcers and erosions.

There are several main factors in the development of ulcerative colitis:

• prolonged use of antibiotics;
• viral and bacterial infections;
• hereditary predisposition;
• congenital and acquired defects of immunity.

Get advice

If you experience these symptoms, we recommend that you make an appointment with your doctor. Timely consultation will prevent negative consequences for your health.

To learn more about the disease, prices for treatment and sign up for a consultation with a specialist, you can call:

+7 (495) 292-39-72

Request a call back
Book online

Why SM-Clinic?

1

Treatment is carried out in accordance with clinical guidelines

2

Comprehensive assessment of the nature of the disease and treatment prognosis

3

Modern diagnostic equipment and own laboratory

4

High level of service and balanced pricing policy

Diagnosis of ulcerative colitis

The proctologist deals with the diagnosis and treatment of pathology. First of all, the specialist collects complaints and anamnesis, and then examines the patient, including a digital examination of the rectum.

For further research and differentiation from Crohn’s disease and other diseases of this type, a comprehensive diagnostic examination of the patient is required. The main most important procedures are colonoscopy with intestinal biopsy and sigmoidoscopy. These methods allow you to visually assess the condition of the colon mucosa.

To clarify the presence of edema, perforations, ulcers and other formations (inflammatory polyps, thickenings, and so on), an X-ray examination may be prescribed.

In addition to instrumental methods, laboratory diagnostics are performed:

• total fecal analysis;
• complete blood count to detect leukocytosis and anemia;
• fecal analysis to determine the severity of the inflammation process;
• biochemical blood test to exclude concomitant pathologies;
• Examine feces for clostridium toxins A and B to rule out clostridial intestinal infection.

Expert opinion

Ulcerative colitis is a dangerous disease that, if left untreated, can cause severe life-threatening consequences. At the same time, there is a high probability that urgent surgical intervention will be required to eliminate them. Complications of NUC can affect not only the intestines, but also many other vital organs.

Timely medical diagnosis makes it possible to detect the disease even in the remission phase and take it under control. At the same time, the quality of life of the patient will improve significantly, and exacerbations will occur much less frequently. With ulcerative colitis, it is extremely important to diagnose the disease before severe complications appear: persistent diarrhea, bleeding, etc. This will avoid surgical intervention and confine itself to conservative therapy.

Matyukhin Anatoly Andreevich

Gastroenterologist, hepatologist, Ph.D.

Treatment of ulcerative colitis

Tactics of therapy is selected depending on the degree of intestinal damage and the severity of the course of the disease. If only the rectum is affected, outpatient treatment is sufficient in most cases. With left-sided and widespread colitis, hospitalization is necessary.

Treatment for ulcerative colitis includes diet, drug therapy, and, if necessary, surgery.

Conservative treatment

The main goal of drug therapy is to relieve the symptoms of the disease and stop the development of inflammation and ulceration.

In ulcerative colitis, a doctor prescribes several groups of drugs:

• painkillers;
• antidiarrheals;
• immunosuppressants;
• iron preparations for anemia;
• non-steroidal and hormonal anti-inflammatory drugs.

Diet plays an important role in the therapy process. The patient is forbidden to eat foods rich in fiber, as well as fried, fatty, spicy, salty and sour foods. At the same time, it is recommended to eat more protein foods.

During a severe exacerbation, a complete refusal to eat may be recommended in order to facilitate bowel movements. In this case, nutrients are injected into the body intravenously.

Surgery

If conservative treatment fails, surgeons excise the affected part of the colon. After that, a reservoir is formed from the area of ​​the small intestine, which takes over the functions of the remote department. With a small lesion, the use of a graft is not necessary.

Prevention of ulcerative colitis

Since the causes of ulcerative colitis are not fully understood, the main preventive measure is to maintain a healthy lifestyle:

• minimization of stressful situations;
• maintaining proper diet;
• smoking cessation and alcohol abuse;
• maintenance of moderate physical activity.

Rehabilitation

After the operation, the patient can return to normal life in 2-3 weeks. In the presence of severe complications, full recovery of capacity can take up to four months. After discharge from the hospital, the patient must comply with all the instructions of the attending physician and register with the dispensary. Until the tissues heal, it is necessary to limit physical activity, carrying weights, thermal procedures, and insolation. In order to maintain a normal state of health, it is recommended to undergo annual spa treatment. The diet is for life.

Question-answer

In the absence of treatment against the background of UC, severe complications may develop, these include:

• toxic dilatation (expansion) of the large intestine;
• profuse intestinal bleeding;
• perforation of the colon wall;
• stricture (narrowing) of the intestine;
• colorectal cancer.

Ulcerative colitis does not go away on its own. Delay in seeking medical help can lead to life-threatening complications.

Ishutina IN Therapeutic aspects of nonspecific ulcerative colitis // BMIK. 2015. No. 5.

Andreeva NA X-ray examination in nonspecific ulcerative colitis // BMIK. 2014. No. 11.

Stepanov Yu.M., Psareva I.V. Clinical and endoscopic parallels in nonspecific ulcerative colitis // Gastroenterology. 2019. №3.

Tikhonova TA Objective and subjective approaches in the management of patients with bowel diseases // BMIK. 2014. No. 5.

Tazhibaeva F.R., Mamasaidov A.T., Zhalalova G.T. New aspects of the treatment of nonspecific ulcerative colitis // Territory of Science. 2016. No. 1.

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