Figure 4
Figure 3
Identify Patient at
Low Risk for Colectomy
• Limited anatomic extent
• Mild endoscopic disease
Identify Patient at
High Risk for Colectomy
• Extensive colitis
• Deep ulcers
• Age <40
• Steroid-requiring
disease
• High CRP and ESR
• History of
hospitalization
• C. difficile infection
• CMV infection
Stratify According to Colectomy Risk
3
Inductive and Maintenance Therapy
(Low Risk)
4
Inductive Therapy
• Oral 5ASA, and/or
• Rectal 5ASA, and/or
• Oral budesonide, or
prednisone, and/or
• Rectal steroids
Rectal 5ASA is first line therapy
in distal UC
Maintenance Therapy
• Maintenance with oral
5ASA and/or rectal 5ASA
• Taper steroid over 60 days
Remission
Inductive and
Maintenance Therapy
(High Risk, Outpatient)
5
Inductive and
Maintenance Therapy
(High Risk, Outpatient)
5
No Remission Relapse
AGA Institute Guideline on the Identification,
Assessment and Initial Medical Treatment of Ulcerative Colitis
