Management of Ascending Colon Colitis

Initial Diagnostic Approach

The American Gastroenterological Association recommends excluding infectious causes through stool testing before diagnosing inflammatory bowel disease 1
The European Crohn’s and Colitis Organisation suggests obtaining inflammatory markers and complete blood count to assess disease activity 1
The American College of Gastroenterology recommends performing colonoscopy with biopsies to confirm diagnosis, assess extent and severity, and rule out malignancy in any stricturing disease 2, 3

The Infectious Diseases Society of America recommends metronidazole 500 mg three times daily orally for 10 days for non-severe C. difficile infection 1
The American College of Gastroenterology recommends avoiding antibiotics for Shiga toxin-producing E. coli as they increase complication risk 1
The European Crohn’s and Colitis Organisation suggests combination therapy with topical mesalamine 1 g daily PLUS oral mesalamine 2.4-4 g daily for mild to moderate ulcerative colitis 1, 6

The American Gastroenterological Association recommends joint management by gastroenterologist and colorectal surgeon from the outset 4, 7, 5
The European Crohn’s and Colitis Organisation suggests intravenous corticosteroids, such as hydrocortisone 400 mg/day or methylprednisolone 60 mg/day, for moderate to severe disease 1
The American College of Gastroenterology recommends subcutaneous low-molecular-weight heparin for thromboprophylaxis 4, 7, 1

The World Journal of Emergency Surgery recommends emergency surgery for hemodynamic instability, free perforation, toxic megacolon, or massive hemorrhage 9, 2, 3
The American College of Surgeons suggests subtotal colectomy with ileostomy as the procedure of choice for severe/fulminant disease 9, 2, 3

The American Gastroenterological Association recommends lifelong maintenance therapy with aminosalicylates, azathioprine, or mercaptopurine 4, 7, 1

The European Crohn’s and Colitis Organisation recommends never delaying corticosteroids while awaiting stool cultures in suspected severe ulcerative colitis 4, 5
The American College of Gastroenterology suggests never using anti-diarrheal medications in severe colitis 1
The American Gastroenterological Association recommends never continuing IV corticosteroids beyond 7-10 days without escalating to rescue therapy or surgery 1