Digestive Health Inflammatory Bowel Disease Ulcerative Colitis What Is Acute Ulcerative Colitis? By Rebecca Valdez, MS, RDN Rebecca Valdez, MS, RDN LinkedIn Rebecca Valdez is a registered dietitian nutritionist and nutrition communications consultant, passionate about food justice, equity, and sustainability. Learn about our editorial process Published on September 28, 2021 Medically reviewed by Robert Burakoff, MD, MPH Medically reviewed by Robert Burakoff, MD, MPH LinkedIn Robert Burakoff, MD, MPH, is board-certified in gastroentrology. He is the vice chair for ambulatory services for the department of medicine at Weill Cornell Medical College in New York. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Causes Symptoms Diagnosis Treatment Prognosis For patients with ulcerative colitis, a chronic disease affecting the mucosal lining of the intestine, symptoms may come and go. While it is an incurable disease, mild to moderate symptoms may be managed with diet and medication. Acute ulcerative colitis is when patients experience a severe flare-up of this inflammatory bowel disease. It is a severe medical condition that can be potentially life-threatening without prompt treatment. Approximately 20 percent of patients diagnosed with ulcerative colitis will experience cases of acute ulcerative colitis that require hospitalization. PeopleImages / Getty Images Causes While the exact cause of ulcerative colitis is unknown, research indicates it is likely a complex interaction of various factors that cause an inappropriate immune response in the intestine. Factors that may interact to cause ulcerative colitis include a person's genetics, age, and gut microbiota, toxic pathogens, and the environment. Ulcerative Colitis: Causes and Risk Factors Some patients with ulcerative colitis are more at risk for experiencing acute ulcerative colitis that requires hospitalization. Risk factors for these severe flare-ups include: Less than 40 years of age at diagnosisExtensive disease (affecting large areas of the intestine)Presence of large or deep ulcersDependency on corticosteroidsNo previous appendectomyHigh levels of inflammationNonsmokers Symptoms Acute ulcerative colitis is a medical emergency, as it indicates the inflammation has spread beyond the lining of the intestine and is impacting the body as a whole (systemic). If you experience symptoms of acute ulcerative colitis, it is important to seek hospitalization. Prompt treatment can be life-saving. Symptoms of acute ulcerative colitis include: Severe abdominal pain Heavy diarrhea Bleeding Fever Abdominal or colonic distension Signs of systemic toxicity Signs and Symptoms of Ulcerative Colitis Diagnosis Acute ulcerative colitis is diagnosed based on the severity of symptoms, lab tests, and imaging. There are two systems used to define acute ulcerative colitis: the Truelove and Witts criteria, and the Mayo Clinic scoring system. Following the Truelove and Witts criteria, acute ulcerative colitis is defined as: Six or more bloody bowel movements per day AND at least one of the below: Heart rate greater than 90 bpm (beats per minute)Temperature greater than 37.8 C (100 F)Hemoglobin less than 10.5 g/dL (grams per deciliter), and/orErythrocyte sedimentation rate greater than 30 mm/h (millimeters per hour) Truelove and Witts Criteria - Disease Severity Score Variable Mild Severe Fulminant Number of stools/day <4 >6 >10 Blood in stool Intermittent Frequent Continuous Temperature, C Normal >37.5 >37.5 Pulse (bpm) Normal >90 >90 Hemoglobin Normal <75% normal Transfusion required Erythrocyte sedimentation rate (mm/h) ≤30 >30 >30 Colonic features on radiograph None Air, edematous wall, thumbprinting Colonic dilation Clinical signs None Abdominal tenderness Abdominal distention and tenderness Following the Mayo Clinic system, acute ulcerative colitis is defined as: Score of 6-12 AND Endoscopic subscore of 2 or 3 Mayo Clinic Scoring System for Ulcerative Colitis Stool Pattern Score Most Severe Rectal Bleeding of the Day Score Normal number of daily bowel movements 0 None 0 1-2 more bowel movements than normal 1 Blood streaks seen in the stool less than half of the time 1 3-4 more bowel movements than normal 2 Blood in most stool 2 5 or more bowel movements than normal 3 Pure blood passed 3 Endoscopic Findings Score Normal/inactive colitis 0 Erythema, decreased vascularity 1 Friability, marked erythema, erosions 2 Ulcerations, severe friability, spontaneous bleeding 3 How Ulcerative Colitis Is Diagnosed Treatment Optimal treatment of acute ulcerative colitis requires a multidisciplinary team approach including a gastroenterologist specializing in IBD, an abdominal surgeon, a radiologist, the IBD nurse, and a nutritionist. What Is a Gastroenterologist? Intravenous Corticosteroids The first line of care for acute ulcerative colitis is the use of intravenous corticosteroids.Corticosteroids are a class of drugs that act similarly to the hormone cortisol, which the body naturally produces to reduce inflammation or calm an overactive immune response. Corticosteroids are immediately administered to patients hospitalized for acute ulcerative colitis. Hydration, Electrolytes, and Nutritional Status In addition to corticosteroids to reduce inflammation, most patients need intravenous fluids. These treat dehydration and correct electrolyte imbalance due to severe diarrhea, vomiting, and bleeding. Patients are at most risk for hypokalemia and iron deficiency anemia. In some cases, enteral nutrition support may also be helpful. Immunosuppressive Drugs For patients who don't respond to corticosteroids after three days, medical rescue therapy with an immunosuppressive drug may be attempted. Drugs typically used include Avsola (infliximab) or cyclosporine. Both drugs have equal effectiveness in medical rescue therapy with 70 percent to 75 percent of patients responsive in the short term and 50 percent in the long term. Surgery Unfortunately, not all patients will respond to medical and rescue therapy, and surgery must be considered within 3 to 5 days for the safety and health of the patient. Approximately 10 percent to 20 percent of patients admitted to the hospital for acute ulcerative colitis will need a colectomy compared with 30 percent to 40 percent of patients who have been hospitalized one or more times for flare-ups. Colectomy is the only treatment that will "cure" acute ulcerative colitis. It is the complete removal of the tissue that is inflamed, which prevents future reoccurrence. However, there are consequences. Removal of the colon and/or parts of the intestine results in significant changes in the body's functions as well as potential complications from the surgery. How Ulcerative Colitis Is Treated Prognosis Acute severe ulcerative colitis is a life-threatening condition associated with significant morbidity and mortality. However, prompt medical treatment of the disease can prevent it. Since the use of corticosteroids, mortality from acute ulcerative colitis has decreased from 30 percent to 40 percent to approximately 1 percent to 2.9 percent. Approximately 65 percent of patients will respond to corticosteroids administered intravenously. As ulcerative colitis is incurable, the patient's status should be continuously monitored and evaluated. The Risks of Untreated Ulcerative Colitis A Word From Verywell If you've been diagnosed with ulcerative colitis, speak with your doctor about how you may be able to manage your symptoms and minimize the risk of having a severe flare-up of acute ulcerative colitis. Timely management is crucial. Learn to catch the early signs and symptoms to ensure the best possible prognosis. If you suspect you are experiencing acute ulcerative colitis, do not hesitate to seek emergency treatment and hospitalization. 8 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Hindryckx P, Jairath V, D’Haens G. Acute severe ulcerative colitis: from pathophysiology to clinical management. Nat Rev Gastroenterol Hepatol. 13(11):654-664. doi:10.1038/nrgastro.2016.116 Feuerstein JD, Isaacs KL, Schneider Y, et al. AGA clinical practice guidelines on the management of moderate to severe ulcerative colitis. Gastroenterology. 158(5):1450-1461. doi:10.1053/j.gastro.2020.01.006 Gulliford SR, Limdi JK. Acute severe ulcerative colitis: timing is everything. Postgraduate Medical Journal. 87(1025):215-222. doi:10.1136/pgmj.2010.107029 American Family Physician. Ulcerative colitis. Holvoet T, Lobaton T, Hindryckx P. Optimal management of acute severe ulcerative colitis (Asuc): challenges and solutions. CEG. 14:71-81. doi:10.2147/CEG.S197719 Jain S, Ahuja V, Limdi JK. Optimal management of acute severe ulcerative colitis. Postgraduate Medical Journal. 95(1119):32-40. doi:10.1136/postgradmedj-2018-136072 Kedia S, Ahuja V, Tandon R. Management of acute severe ulcerative colitis. World J Gastrointest Pathophysiol. 5(4):579-588. doi:10.4291/wjgp.v5.i4.579 Ungaro R, Mehandru S, Allen PB, Peyrin-Biroulet L, Colombel J-F. Ulcerative colitis. Lancet. 389(10080):1756-1770. doi:10.1016/S0140-6736(16)32126-2 By Rebecca Valdez, MS, RDN Rebecca Valdez is a registered dietitian nutritionist and nutrition communications consultant, passionate about food justice, equity, and sustainability. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. Cookies Settings Accept All Cookies