Management of acute severe ulcerative colitis

Expert Rev Gastroenterol Hepatol. 2009 Aug;3(4):395-405. doi: 10.1586/egh.09.24.


Ulcerative colitis is a chronic relapsing and remitting inflammatory disorder that can generally be managed successfully with maintenance oral medications. However, approximately 15% of patients with ulcerative colitis will develop a severe exacerbation and require hospitalization. While many patients with acute severe ulcerative colitis will respond to a short course of intravenous corticosteroids, up to a third will fail to improve. In these patients with steroid-refractory colitis, the choice is between rescue medical therapy with ciclosporin or infliximab, or surgery. Well-timed rescue medical therapy is generally safe when administered by experienced physicians, and is effective in the majority of cases. Surgery is unavoidable in some cases, but is the treatment of choice in others. While ileal pouch-anal anastomosis offers the prospect of life without a permanent ileostomy, there are issues with its long-term functional outcome.

Publication types

  • Review

MeSH terms

  • Acute Disease
  • Adrenal Cortex Hormones / therapeutic use
  • Anti-Inflammatory Agents / adverse effects
  • Anti-Inflammatory Agents / therapeutic use*
  • Antibodies, Monoclonal / therapeutic use
  • Clinical Protocols
  • Colitis, Ulcerative / drug therapy
  • Colitis, Ulcerative / surgery
  • Colitis, Ulcerative / therapy*
  • Colonic Pouches
  • Cyclosporine / therapeutic use
  • Digestive System Surgical Procedures* / adverse effects
  • Drug Resistance
  • Gastrointestinal Agents / adverse effects
  • Gastrointestinal Agents / therapeutic use*
  • Humans
  • Infliximab
  • Patient Selection
  • Proctocolectomy, Restorative
  • Recurrence
  • Risk Assessment
  • Severity of Illness Index
  • Treatment Outcome


  • Adrenal Cortex Hormones
  • Anti-Inflammatory Agents
  • Antibodies, Monoclonal
  • Gastrointestinal Agents
  • Cyclosporine
  • Infliximab