Definition - acute severe attacks of IBD

Severe acute ulcerative colitis is a life threatening condition characterized by:

• severe diarrhoea - > 6 stools per day with blood
• anaemia - Hb < 10 g/dL
• fever - > 37.5
• tachycardia - > 90 bpm
• raised ESR (and CRP) - ESR > 30mm per hour
• low albumin - < 30 g/L

This condition should be managed in hospital.

• mainstay of treatment is with IV steroids - such as methylprednisolone or hydrocortisone
• intravenous ciclosporin may be an option for patients intolerant to IV steroids

Colectomy is indicated in severe ulcerative colitis which fails to respond to medical therapy within 7 to 10 days.

Reference

1. NICE. Ulcerative colitis: management. NICE guideline NG130. Published May 2019, reviewed February 2025