Describe the approach.
Choose medical therapy based on disease severity and disease extent.
If remission is achieved, initiate maintenance therapy.
Continue the treatment used to achieve remission, with the exception of corticosteroids.
If remission is not achieved, escalate treatment.
Consult surgery for consideration of curative proctocolectomy if medical therapy is unsuccessful or complications occur.
Screen for colorectal cancer and other common comorbidities (e.g., depression and anxiety).
Describe the pharmacological treatment.
Pharmacological therapy is used to induce and maintain disease remission.
Goals of treatment
Initially: symptomatic remission
Long-term: mucosal healing
Describe the supportive therapy.
Treat pain as needed.
Nonpharmacological measures, e.g., heating pads
Consider acetaminophen, anxiolytics, and sedatives.
Avoid opioids and NSAIDs.
Avoid parenteral nutrition unless required to improve nutritional status prior to colectomy.
Identify and treat any micronutrient deficiency.
Describe the surgical treatment.
Ulcerative colitis can be cured surgically. Surgical treatment also reduces the risk of colorectal cancer.
Complications of ASUC
Refractory ulcerative colitis (i.e., no response after 3–5 days of medical management and/or corticosteroid dependence)
Dysplasia or carcinoma
Procedure: restorative proctocolectomy with an ileal pouch-anal anastomosis (IPAA or J pouch)
Resection of the entire colon and rectal mucosa while sparing the anal sphincters.
Loops of small intestine (serving as the pouch) are used to create an artificial rectum, resulting in a continence-conserving connection between the ileum and anus.
Complications of surgery
Early (≤ 30 days): anastomotic leak, pelvic sepsis
Late: bowel stricture, bowel obstruction, fertility issues, sexual dysfunction 
Most common late postoperative issue: pouchitis (increased stool frequency, malaise, and possibly incontinence caused by bacterial overgrowth)