ABSTRACT
This chapter is concerned with the management of acute fulminating colitis of any aetiology. A test for Clostridium difficile should be included as pseudomembranous colitis can occur in the immunocompromised colitic patient. Acute severe colitis can occur without any previous history of bowel disorder. Acute colitis is characterised by abrupt onset of bloody diarrhoea, tenesmus, urgency, abdominal colic, and profound anorexia. Corticosteroids represent the first line of medical management of acute ulcerative colitis (UC). Ciclosporin can be given as intravenous, oral or enema formulations, but intravenous administration is used initially in severe UC. Patients with previous chronic medically refractory colitis are more likely to require colectomy than those who are thiopurine or anti-TNF naive. Faecal microbiota transplantation is rapidly gaining momentum as an effective treatment for colitis related to antibiotic refractory Clostridium difficile infection, but also as an experimental treatment for active UC. Toxic dilatation often occurs during a first attack of colitis.
