Management
There have been massive improvements in the management of ulcerative colitis in the past 40 or 50 years, as evidenced by the death rates in severe attacks:
- before 1952, 45%
- now, 1 to 2 %
The management has been improved by:
- corticosteroids, biologics and Janus kinase inhibitors
- better understanding of fluid balance and electrolytes in severely ill patients
- better understanding of indicators of severity of the disease
Note that all the management strategies listed here require considerable modification in children.
Be aware that there may be an increased likelihood of needing surgery for people with any of the following:
- stool frequency more than 8 per day
- pyrexia
- tachycardia
- an abdominal X-ray showing colonic dilatation
- low albumin, low haemoglobin, high platelet count or C-reactive protein (CRP) above 45 mg/litre (bear in mind that normal values may be different in pregnant women)
Reference
- Ungaro R, Mehandru S, Allen PB, et al; Ulcerative colitis. Lancet. 2017 Apr 29;389(10080):1756-1770.
- NICE. Ulcerative colitis: management. NICE guideline NG130. Published May 2019, reviewed February 2025
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