Sammanfattning
A severe attack is seen in approximately 15 % of patients with ulcerative colitis. Early recognition of the disease, prompt initiation of medical treatment and objective evaluation of response to therapy are crucial in the management of the patient. The present mortality rate is below 1%, but colectomy rates have remained unchanged at about 30%. Close collaboration between the gastroenterologist and the surgeon is therefore essential. Corticosteroids remain a mainstay in the treatment. Early recognition of steroid-resistant disease is important in order to offer these patients rescue medical therapy or colectomy. Ciclosporin use has been limited in Sweden because of concerns about toxicity. Rescue therapy with a single infusion of infliximab has reduced colectomy rates at 3 months and at follow-up 3 years later. The optimal rescue therapy and the most effective maintenance treatment need to be defined by future trials.