Why is it important?
Acute severe colitis is a potentially life-threatening condition. Between 15-25% of patients with Ulcerative Colitis will need to be hospitalised due to an acute, severe flare up at some stage of their journey. Often this will be the first presentation of their disease.
When a flare occurs in colitis, it can change and deteriorate rapidly. Patients need fast and close monitoring and review by appropriate specialists. Children experiencing an acute episode need immediate access to a paediatric gastroenterologist.
The monitoring stage should include stool cultures to exclude infectious causes, as well as flexible sigmoidoscopy. When it comes to escalating from intravenous steroids to ciclosporin or infliximab rescue therapy or to surgery, it’s important to make decisions quickly to avoid severe complications. (Intravenous steroids will fail for nearly half of patients.)
If the disease doesn’t respond to medical therapy, the side effects of medication are intolerable, or there’s a life-threatening haemorrhage, toxic megacolon or perforation, an emergency subtotal colectomy should be performed.