Ulcerative Colitis
Summary
Ulcerative colitis is a chronic inflammatory bowel disease characterised by continuous mucosal inflammation starting from the rectum and extending proximally. Patients present with bloody diarrhoea, urgency, and tenesmus. Severity is assessed using Truelove and Witts criteria. Mild-moderate disease is treated with 5-ASA; moderate-severe requires steroids and biologics. Acute severe UC is a medical emergency.
Key Facts
- Definition: Continuous mucosal inflammation of colon starting at rectum
- Incidence: 5-25 per 100,000 per year
- Pathognomonic: Bloody diarrhoea + continuous inflammation from rectum
- Gold Standard Investigation: Colonoscopy + biopsy
- First-line Treatment: 5-ASA (mild); steroids + biologics (moderate-severe)
- Prognosis: 10-15% require colectomy
Clinical Pearls
Extent Pearl: Proctitis, left-sided, or pancolitis - affects treatment choice.
5-ASA Pearl: Topical + oral 5-ASA more effective than either alone.
Acute Severe Pearl: IV steroids; if no response day 3 - rescue therapy or surgery.
| Feature | Mild | Severe |
|---|---|---|
| Stools/day | less than 4 | 6+ with blood |
| Pulse | Normal | greater than 90 |
| Temperature | Normal | greater than 37.8 |
| Hb | Normal | less than 105 |
| ESR | Normal | greater than 30 |
Algorithm
Maintenance
| Severity | Treatment |
|---|---|
| Mild | Mesalazine (oral +/- rectal) |
| Moderate | Steroids for flare; azathioprine maintenance |
| Severe | Biologics (anti-TNF, vedolizumab, tofacitinib) |
Acute Severe UC
- IV hydrocortisone 100mg QDS
- Monitor with Travis criteria
- Day 3: rescue therapy (infliximab/ciclosporin) or colectomy
-
Ungaro R et al. Ulcerative colitis. Lancet. 2017;389(10080):1756-1770. PMID: 27914657
-
NICE guideline NG130. Ulcerative colitis: management. 2019.
Viva Points
"UC: continuous from rectum, mucosal, bloody diarrhoea. Truelove-Witts severity. 5-ASA for mild. Acute severe = IV steroids, rescue or surgery day 3."
Last Reviewed: 2026-01-01 | MedVellum Editorial Team