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Colorectal SurgeryManagement

Acute Severe Ulcerative Colitis Management (ECCO/AGA)

Acute Severe Ulcerative Colitis Management (ECCO/AGA): Acute Severe UC (Truelove-Witts) → Hospital Admission → Day 3 Assessment (Oxford Criteria) → Resp...

Pathway Overview

9 steps

Algorithm Steps

9 total

  1. 01Start

    Acute Severe UC (Truelove-Witts)

    ≥6 bloody stools/day + systemic toxicity

  2. 02Action

    Hospital Admission

    IV steroids, VTE prophylaxis, surgical consult

    • Hydrocortisone 100mg QID or methylpred
    • NPO if toxic megacolon
    • Daily stool frequency, CRP
  3. 03Decision

    Day 3 Assessment (Oxford Criteria)

    CRP and stool frequency

  4. 04Action

    Responding

    Continue IV steroids, plan transition

  5. 05End

    Transition to Oral Steroids

    Add maintenance therapy

  6. 06Action

    Not Responding

    >8 stools or CRP>45 with 3-8 stools

  7. 07Decision

    Rescue Therapy

    • Infliximab
    • Cyclosporine
    • Surgery
  8. 08Action

    Infliximab

    5-10 mg/kg, accelerated dosing

  9. 09End

    Subtotal Colectomy

    If rescue fails or perforation/megacolon

  10. Path rejoins step 09Shared downstream outcome

Guideline Source

ECCO Acute Severe Ulcerative Colitis Guidelines

DOI: 10.1093/ecco-jcc/jjaa001View Guideline

Clinical Safety Information

Clinical Decision Support — Not a Substitute for Clinical Judgment

Individual patient factors may require deviation from these recommendations.

Known Limitations

  • Truelove-Witts criteria define severity
  • Day 3 response assessment critical
  • Surgical backup essential

Applicable Regions

USAUUKEU

EU: ECCO guidelines standard

US: AGA guidelines

Version 1Next review: 2028-01-01

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Frequently Asked Questions

What is the Acute Severe Ulcerative Colitis Management (ECCO/AGA)?

The Acute Severe Ulcerative Colitis Management (ECCO/AGA) is a management clinical algorithm for Colorectal Surgery. It provides a structured decision tree to guide clinical decision-making, based on ECCO Acute Severe Ulcerative Colitis Guidelines.

What guideline is the Acute Severe Ulcerative Colitis Management (ECCO/AGA) based on?

This algorithm is based on ECCO Acute Severe Ulcerative Colitis Guidelines (DOI: 10.1093/ecco-jcc/jjaa001).

What are the limitations of the Acute Severe Ulcerative Colitis Management (ECCO/AGA)?

Known limitations include: Truelove-Witts criteria define severity; Day 3 response assessment critical; Surgical backup essential. Individual patient factors may require deviation from these recommendations.

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