Ulcerative colitis was first described in 1859, but it was not until the early 20th century that it became a well recognized clinical entity. The patients of the old series showed high mortality rate ranging from 30% in the severe forms to 60% in the fulminating forms. The introduction of
corticosteroids in the 1950s dramatically improved the prognosis of patients with severe
ulcerative colitis. The strategy based on intensive medical treatment, early detection of risk factors and early surgery progressively reduced the mortality rate to less than 1%.
Tachycardia,
fever, reduced number of intestinal sounds, hypoalbuminaemia, hypokalaemia metabolic
alkalosis and elevated
C-reactive protein were recognized to be the most useful risk factors. Plain abdominal X-ray remains the very reliable suitable tool to detect early complications of severe
colitis. Once reduced the mortality near to zero, treatment has been addressed to avoid
colectomy.
Cyclosporine and
Infliximab are currently used as rescue
therapy, however, despite the high remission rates achieved with both drugs, about 50% of the treated patients ultimately will come to
colectomy over the next few years.