Clinical features: Ulcerative colitis is a chronic condition of unknown cause in which there are changes in the structure of the mucosa and submucosa of the wall of the colon, with widespread inflammation and superficial ulceration. Symptoms vary from diarrhoea in mild cases to septicaemia, dehydration and malnutrition in severe forms. Diarrhoea, with blood and mucus in the faeces, is a common sign, although the disease is confined to the rectum there may be paradoxically constipation.
Treatment guidelines
• Refer to specialist.
• Localized disease - treat with topical steroids:
Prednisalone (enema) 20 mg at night; or same dose via rectal catheter.
CAUTION Give steroids only in confirmed cases of U.C. Exclusion of infective colitises (especially amoebic) is vital; a therapeutic trial of metronidazole should be given. |
Widespread colitis:
Sulphasalazine (O) 1 gram four times a day for acute disease, reducing to 500 mg four times a day for maintenance (caution in G6PD deficiency)
Plus
Prednisolone (O) 30-60 mg once daily for severe acute and extensive disease; reduce gradually according to disease severity.
Sulphasalazine (O)
Children over 2 years. Acute attack |
40 - 60 mg/kg body weight daily |
Maintenance dose |
20 - 30 mg/kg body weight daily. |
NOTE Life long follow up is required. |
