Moderate to Severe Ulcerative Colitis

Publication Date: January 13, 2020

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

...iagnosis...

...le 1. Disease Severity Scoring Syste...


Treatment

Treatment

...adult outpatients with moderate-severe ulcerat...


...t outpatients with moderate-severe ulcera...


...lt outpatients with moderate-severe ulcerati...


...dult outpatients with moderate-severe u...


...ients with active moderate-severe ulc...


...tpatients with moderate-severe ulcerative colit...


...adult outpatients with active moderate-sever...


...n adult outpatients with moderate-severe ulcerat...


...patients with moderate-severe ulcerative...


...patients with moderate-severe ulcerative colit...


...ients with moderate-severe ulcerative...


...dult outpatients with moderate-severe ulcerative...


In hospitalized adult patients with acute sever...


...hospitalized adult patients with acute severe...


...alized adult patients with acute severe...


...lized adult patients with acute severe...


...igure 1. Pharmacological Management of Adult...


Figure 2. Pharmacological Manageme...