Diagnosis of acute severe ulcerative colitis in adults

Acute severe ulcerative colitis is a medical emergency; it requires admission to hospital and early specialist management by a multidisciplinary team. Early surgical consultation is essential.

Acute severe ulcerative colitis is defined by the presence of 6 or more bloody stools per day, plus at least one of the following:

• temperature more than 37.8ºC
• heart rate more than 90 beats/minute
• haemoglobin less than 105 g/L
• erythrocyte sedimentation rate more than 30 mm/hour.

Patients with ulcerative colitis are often taking immunomodulatory drugs, so infective causes (eg Clostridioides difficile [formerly known as Clostridium difficile], cytomegalovirus infection, amoebic colitis, other bacterial causes of colitis) should always be considered when a patient presents with gastrointestinal symptoms. If gastrointestinal infection is excluded, there is no role for antibiotic therapy.