Diagnosis and medical treatment of ulcerative colitis.

Acute attacks of ulcerative colitis should be treated without delay and corticosteroids should be used systemically and topically. For patients with severe attacks, prognostic indicators and criteria for proceeding to urgent colectomy are well defined. In fact, with good medical management the surgeon should only rarely have to operate on a moribund patient, even when an emergency or urgent colectomy is indicated. The mortality rate in patients with severe attacks requiring surgery is low in specialist centres. When patients have gone into remission on corticosteroids, these should be tailed off and the patients maintained indefinitely on sulphasalazine. Currently there is considerable interest in the development of pro-drugs which will contain the 5-aminosalicylic acid moiety but not the sulphapyridine.