The medical management of acute and chronic ulcerative colitis

The current medical therapy of severe, acute ulcerative colitis is reviewed. The role and of 5-ASA, corticosteroids, immunosuppressive agents and surgery are outlined. A systematic approach using a combination of these agents to induce a remission is presented. A model for long term maintenance therapy following a response in the acute setting to avoid steroid dependence and surgery is proposed. The role of surgery in ulcerative colitis should be limited to patients who either fail medical therapy or in whom dysplasia or cancer have been detected. A realistic assessment of the potential pitfalls of surgical intervention, such as ileal pouch-anal anastomosis, is discussed.