Ulcerative colitis is a chronic disease characterized by recurrent exacerbations, varying degrees of damage to the colonic mucosa and complications both intestinal and extraintestinal. The treatment programs should attempt to: (1) terminate the acute attack; (2) prevent recurrent attacks; and (3) promote healing of the damaged mucosa. Long-term therapy may be modified by considerations relating to complications, e.g. carcinoma and ocular disease. Symptomatic remission should not be the only index of therapeutic response.
The choice and intensity of therapy should be determined by the clinical severity of the disease.Severe (Fulminant) disease
Hospitalization. Hospitalization is indicated. Patients with severe disease may deteriorate rapidly with hemorrhage, perforation, toxic megacolon and sepsis developing over a short period of time.
General measures.
Restore circulating blood volume with fluids, plasma and blood as indicated.
Discontinue opiates and anticbolinergics.
Correct electrolyte abnormalities.
Discontinue all oral intake. Institute nasogastric suction if the colon has become dilated.
Antimicrobial therapy. The clinical course of fulminant ulcerative colitis is associated with extensive necrosis of colonic mucosa and perforation with sepsis is not uncommon in this form of the disease. Intravenous antibiotics are given to these patients for presumed or potential sepsis. Ampicillin, cephalothin, cephapirin, chlorampnenical and gentamicine have been used singly or in combination.
Adrenocorticosteroids. Give intravenous hydrocortisone, 300rag daily, or prednisone, 60rag daily in divided doses at 6 to 8 hour intervals.
If the patient with toxic colonic dilation does not improve within 8 to 12 hours, colonic resection is usually indicated. In those patients who have fulminant disease but are not toxic, intravenous therapy is continued for 5 to 7 days. If improvement occurs, oral therapy can be substituted. If the patient fails to respond or deteriorates, colectomy should be considered. Malnourished patients may be benefited by total parenteral nutrition during this phase.
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