Article Text

Download PDFPDF

Optimal management of acute severe ulcerative colitis
  1. Saransh Jain1,
  2. Vineet Ahuja1,
  3. Jimmy K Limdi2
  1. 1 Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
  2. 2 Department of Gastroenterology, Inflammatory Bowel Diseases Section, University of Manchester, Manchester, UK
  1. Correspondence to Dr Jimmy K Limdi, The Pennine Acute Hospitals NHS Trust, Manchester Academic Health Sciences Centre, University of Manchester, Manchester BL97TD, UK; jimmy.limdi{at}


Acute severe ulcerative colitis is a life-threatening medical emergency, which can be associated with significant morbidity and is preventable through prompt and effective management. Corticosteroids remain the cornerstone of initial therapy, although a third of patients will not respond. Further management hinges on timely decisions with use of rescue therapy with ciclosporin or infliximab, without compromising the health or safety of the patient, or timely surgery. Although such patients need specialist care, it is imperative that emergency care physicians are aware of the important principles of management of this condition to achieve successful outcomes. Risk stratification and the use of predictive models using clinical parameters have reduced the morbidity associated with this condition.We discuss current evidence and present a clinical approach to clinicians involved in the emergency care of patients with acute severe ulcerative colitis in this review.

  • inflammatory bowel disease
  • ulcerative colitis
  • acute severe
View Full Text

Statistics from


  • Contributors SJ, JKL and VA conceptualised the topic. SJ, JKL and VA did the literature search and review. SJ and JKL produced the manuscript draft and all three authors were involved with the critical review of the manuscript. All three authors approve the revised and final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.