Severe ulcerative colitis

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Opinion statement

Patients with severe ulcerative colitis should be hospitalized and treated with intravenous corticosteroids for 7 to 10 days. Patients who fail to respond may be offered colectomy or rescue therapy with intravenous cyclosporine. Risks of cyclosporine therapy, including a 1% to 2% risk of death from opportunistic infection and a 50% failure rate after 6 months of follow-up, should be discussed with the patient. Because of the high rate of relapse, patients who elect to be treated with cyclosporine should receive overlapping therapy with prednisone, cyclosporine and azathioprine or 6-mercaptopurine. Azathioprine or 6-mercaptopurine should then be continued long-term for maintenance of remission.