Moderate to Severe Ulcerative Colitis
Key Points
Key Points
- Ulcerative colitis (UC) is a chronic inflammatory bowel disease with peak onset in early adulthood.
- Untreated, the natural history of the disease is one of relapsing and remitting mucosal inflammation.
- Based on population-based cohort studies, the majority of patients with UC have a mild to moderate course, generally most active at diagnosis and then in varying periods of remission or mild activity.
- Approximately 15% patients may experience an aggressive course, and 20% of these patients may require hospitalization for severe disease activity.
- The 5- and 10-year cumulative risk of colectomy is 10–15%, primarily limited to patients with moderate to severe disease activity.
- A subset of hospitalized patients with acute severe ulcerative colitis (ASUC) have short-term colectomy rates of 25–30%.
- Predictors of an aggressive disease course and colectomy are: age <40 at diagnosis, extensive disease, large and/or deep ulcers at endoscopy, presence of extra-intestinal manifestations, early need for corticosteroids and elevated inflammatory markers.
Diagnosis
...Diagnosis...
...1. Disease Severity Scoring SystemsHaving t...
Treatment
...Treatment...
...patients with moderate-severe ulcerative col...
...t outpatients with moderate-severe ulcerative co...
...atients with moderate-severe ulcera...
...outpatients with moderate-severe ulcerative...
...tpatients with active moderate-severe ulcerative...
...adult outpatients with moderate-se...
...tients with active moderate-severe ulce...
...atients with moderate-severe ulcerative co...
...adult outpatients with moderate-sever...
...outpatients with moderate-severe ulcerative colit...
...outpatients with moderate-severe ul...
...dult outpatients with moderate-severe ulce...
...adult patients with acute severe ulcer...
...spitalized adult patients with acute seve...
...ized adult patients with acute severe u...
...adult patients with acute severe ulcerativ...
Figure 1. Pharmacological Management of Adult Pat...
...2. Pharmacological Management of Adult Outpa...