Chronic relapsing inflammation limited to colonic mucosa, extending continuously from rectum.
Clinical features
- • Bloody diarrhoea
- • Tenesmus, urgency
- • Lower abdominal pain
- • Extra-intestinal: arthritis, uveitis, PSC, erythema nodosum
Investigations
- • FBC, CRP, ESR, ferritin, faecal calprotectin
- • Stool culture + C. diff to exclude infection
- • Colonoscopy + biopsy (gold standard)
Diagnosis
- • Truelove-Witts severity classification
Management
- • Mild–moderate: mesalazine PO + topical
- • Moderate–severe: oral prednisolone 40 mg taper
- • Refractory: biologics (infliximab, vedolizumab, ustekinumab)
- • Acute severe (Truelove-Witts): IV hydrocortisone 100 mg q6h, rescue ciclosporin / infliximab, colectomy if no response by day 3–5
Complications
- • Toxic megacolon
- • Colorectal cancer (surveillance from 8 y)
- • VTE during flare
Clinical pearls
- • Faecal calprotectin <50 essentially excludes active IBD
References
- • BSG IBD 2019
- • ECCO UC 2022
Educational — verify locally.
