DR Medhat MRCP

B. Management of ulcerative colitis
Inducing remission: TTT depends on extent & severity of disease.
I. Mild to moderate UC (i.e no need for admission):
Step 1 therapy ; if proctitis or
proctosigmoiditis:
Topical 5-ASA (enema or supp) ±
Oral 5-ASA OR
Topical or oral steroids : if
intolerance or CI of 5-ASA.
Step 1 therapy ; if left sided & extensive
UC :
Oral 5-ASA high dose ± (topical 5-ASA
/oral beclometasone.)
If worsening or no improving of symptoms within 4 weeks
Oral 5-ASA + oral prednisolone
If still inadequate response within 2-4 weeks
Tacrolimus (prograf) + oral prednisolone
II.
Acute severe U.C (requires admission)
Stool frequency > 6/day.
ESR > 30 mm/hr.
HR > 90 bpm.
Temp > 37.8 o C in 2 out of 4 days.
Anemia (Hb < 75% predicted).
Surgery if indicated i.e any of :
Stool frequency > 8/day
Pyrexia
Tachycardia
Colonic dilatation /X-Ray
↓ alb.,↓Hb
↑CRP> 45mm/hr.
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If surgery not indicated
Step 1 therapy : I.V Steroids or
I.V Cyclosporin or surgery
(if steroid intolerance or CI)
Step 2 therapy :
I.V Steroids + I.V Cyclosporin (or Infleximab
if cyclosporine is CI or intolerated) OR
Surgery (if no response within 72 hrs)