Further experience in the treatment of severe attacks of ulcerative colitis

One hundred courses of an intensive intravenous regimen have been used in 87 patients with severe attacks of ulcerative colitis during the past 5 years, 11 of the patients having been treated more than once during separate admissions to hospital. 60% of the attacks responded swiftly to the regimen, and the patients were symptom-free at the end of the 5-day course. In 15% there was improvement but the patients were not entirely symptom-free. In 25% failure to respond resulted in emergency colectomy, the usual operation being proctocolectomy as a single-stage procedure. There were no deaths directly due to ulcerative colitis or to surgical treatment in these patients during the period of the study, the mean period of follow-up being 25 months; but 4 elderly patients died from unrelated causes. These favourable results are better than most published figures. The advantages of the intensive medical regimen are that: (i) many patients quickly go into clinical remission, which is frequently sustained; and (ii) failure to improve can be regarded as a clear-cut indication for emergency surgery.