Bloody diarrhoea in a flare? Contact your doctor or inflammatory bowel disease (IBD) team the same day. If you also have a fever, a fast heartbeat or feel very weak, get urgent medical help: see when to get urgent help.
Acute severe ulcerative colitis is a sudden, serious flare of ulcerative colitis. It can be life-threatening, and it is treated in hospital. Doctors recognise it with the Truelove and Witts criteria, first published in 1955 and still used in a modified form.
The criteria
The British Society of Gastroenterology’s 2019 guideline defines acute severe ulcerative colitis in adults as more than 6 bloody stools a day (the original 1955 criteria and the Montreal classification say 6 or more), plus signs that the whole body is affected, with at least one of:
- a temperature over 37.8 °C (100 °F)
- a pulse over 90 beats a minute
- a haemoglobin (Hb or Hgb, part of a blood count) under 105 g/L (10.5 g/dL)
- a CRP (C-reactive protein, a blood test for inflammation) over 30 mg/L (3.0 mg/dL)
The last two need a blood test, so this page has no calculator. For teenagers, the guideline uses the PUCAI instead: a score of 65 or more is treated the same way.
What happens next
The guideline recommends that adults who meet these criteria, and teenagers with a PUCAI of 65 or more, are admitted to hospital for assessment and intensive treatment. That usually means steroids into a vein, tests to rule out infection, and close daily checks, with other medicines or surgery considered if the flare doesn’t settle.
Sources
- Lamb CA, Kennedy NA, Raine T, et al. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut 2019;68(Suppl 3):s1-s106 (statement 15)
- Truelove SC, Witts LJ. Cortisone in ulcerative colitis: final report on a therapeutic trial. Br Med J 1955;2(4947):1041-1048
- Satsangi J, Silverberg MS, Vermeire S, Colombel JF. The Montreal classification of inflammatory bowel disease. Gut 2006;55(6):749-753