Complication Of Ulcerative Colitis Research Articles

2-Stage and 3-stage restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis show comparable short- and long-term outcomes

Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) represents the standard treatment for therapy-refractory, malignant or complicated ulcerative colitis (UC) and can be performed as a 2-stage or 3-stage procedure. This study aimed to compare the short- and long-term outcomes after 2- and 3-stage IPAA in patients with UC in our department. A retrospective analysis of 176 patients with UC who received 2- or 3-stage restorative proctocolectomy with IPAA at our institution from 2001 to 2021 was performed. Outcomes for short-term (morbidity, longer hospital stay, readmission) and long-term (pouch failure and quality of life) parameters were compared between the 2- and 3-stage procedure. Regarding short-term outcomes for all patients, in-hospital morbidity and readmission rates after any surgical stage were observed in 69% and 24%, respectively. Morbidity and readmission did not differ significantly between the 2- and 3-stage procedure in uni- and multivariate analysis. Median length of hospital stay for all stages was 17 days. The 3-stage procedure was identified as an independent factor for longer hospital stay (OR 3.8 (CI 1.3–10.8), p = 0.014). Pouch failure and failure of improved quality of life during long-term follow-up occurred both in 10% of patients, with no significant differences between the 2- and 3-stage procedure in uni- and multivariate analysis. Our data suggest that both the 2- and 3-stage proctocolectomy with IPAA demonstrate favourable and comparable postoperative short- and long-term outcomes, with a high rate of improved quality of life in patients with UC.

S3931 Hiding in Plain Sight: A Rare Cardiac Complication of Ulcerative Colitis

S3931 Hiding in Plain Sight: A Rare Cardiac Complication of Ulcerative Colitis

Clinical profile and short-term outcomes of acute severe ulcerative colitis in Vietnam: insights from a resource-limited setting.

Acute severe ulcerative colitis (ASUC) is a significant complication of ulcerative colitis, affecting roughly 25% of patients and increasing the risk of colectomy and hospital mortality. While intravenous steroids are a primary treatment, only 67% of patients respond, necessitating rescue therapy for non-responders. Data on ASUC in the Vietnamese population are scarce. This study aims to provide insights into the clinical characteristics and short-term outcomes of Vietnamese patients with ASUC. We conducted a prospective case series on ASUC patients admitted to the University Medical Center in Ho Chi Minh City from January 2021 to June 2023. Steroid response was assessed using the Travis Oxford criteria. We evaluated clinical features, in-hospital steroid response rates, endoscopic remission, and colectomy rates 12 months post-hospitalization. Seventeen patients with a median age of 42 years (70.6% male) were included. The median time from symptom onset to diagnosis was six weeks, and 47.1% had a history of ulcerative colitis. Median CRP value was 75.8 mg/L, and 76.5% had fecal calprotectin concentrations above 800 µg/g. All patients had a Mayo endoscopic subscore of ≥2, with 12.5% showing deep ulcers. Eleven patients (64.7%) responded to in-hospital steroid treatment, while 6 (35.3%) required rescue therapy with infliximab or tofacitinib. After one year, 10 of 11 (90.1%) achieved mucosal healing, and no patients underwent colectomy. Corticosteroids remain the cornerstone for initial ASUC therapy, though many patients do not respond. Anti-TNF agents and tofacitinib show potential benefits for those unresponsive to steroids. This study highlights the effectiveness of corticosteroids and biologics in managing ASUC in Vietnam.

S3939 Unveiling the Uncommon: Pyoderma Gangrenosum as an Extraintestinal Complication of Ulcerative Colitis

S3939 Unveiling the Uncommon: Pyoderma Gangrenosum as an Extraintestinal Complication of Ulcerative Colitis

Ulcerative colitis and concomitant arterial hypertension (literature review)

ulcerative colitis is a complex disease that results from a complex interaction of genetic predisposition, environmental factors, which leads to dysregulation of the immune system, chronic intestinal inflammation with damage to the mucous membrane. Systemic chronic inflammation can cause the development of arterial hypertension, thereby complicating the course of the primary disease. However, the cause-and-effect relationship between these diseases is not fully understood. Early detection of high blood pressure in patients with ulcerative colitis, a multidisciplinary approach to diagnosis makes it possible to achieve optimal treatment results in a timely manner and prevent the occurrence of intestinal complications. The aim of this study was to provide a comprehensive review of diagnostic procedures such as colonoscopy, inflammatory biomarkers (faecal calprotectin, faecal lactoferrin, serum zonulin), and to study the features of the colon structure in ultrasound diagnostics in patients with ulcerative colitis and concomitant hypertension. The data from PubMed and Ukrainian scientific sources on the comorbidity of these diseases, the possibility of using non-invasive diagnostic methods to assess the condition of the intestine in patients with ulcerative colitis and arterial hypertension were analysed. The literature review includes 50 scientific sources. The main focus is on the pathophysiological relationships of diseases, peculiarities of non-invasive diagnosis of ulcerative colitis during follow-up and early detection of arterial hypertension, which makes it possible to prevent complications in ulcerative colitis. Given the literature review, it can be concluded that the problem of timely diagnosis of hypertension in patients with ulcerative colitis is relevant today. For a rational approach to the management of patients with ulcerative colitis and concomitant hypertension, it is necessary to carry out a set of diagnostic procedures, including outpatient blood pressure measurement, ultrasound examination of the intestinal wall, and the use of non-invasive inflammatory biomarkers.

Effect of obesity on postoperative complications in ulcerative colitis: A systematic review and meta‐analysis

Effect of obesity on postoperative complications in ulcerative colitis: A systematic review and meta‐analysis

Ileal Paneth Cell Phenotype is a Cellular Biomarker for Pouch Complications in Ulcerative Colitis.

Biomarkers that integrate genetic and environmental factors and predict outcome in complex immune diseases such as inflammatory bowel disease (IBD; including Crohn's disease [CD] and ulcerative colitis [UC]) are needed. We showed that morphologic patterns of ileal Paneth cells (Paneth cell phenotype [PCP]; a surrogate for PC function) is one such cellular biomarker for CD. Given the shared features between CD and UC, we hypothesized that PCP is also associated with molecular/genetic features and outcome in UC. Because PC density is highest in the ileum, we further hypothesized that PCP predicts outcome in UC subjects who underwent total colectomy and ileal pouch-anal anastomosis (IPAA). Uninflamed ileal resection margins from UC subjects with colectomy and IPAA were used for PCP and transcriptomic analyses. PCP was defined using defensin 5 immunofluorescence. Genotyping was performed using Immunochip. UC transcriptomic and genotype associations of PCP were incorporated with data from CD subjects to identify common IBD-related pathways and genes that regulate PCP. The prevalence of abnormal ileal PCP was 27%, comparable to that seen in CD. Combined analysis of UC and CD subjects showed that abnormal PCP was associated with transcriptomic pathways of secretory granule maturation and polymorphisms in innate immunity genes. Abnormal ileal PCP at the time of colectomy was also associated with pouch complications including de novo CD in the pouch and time to first episode of pouchitis. Ileal PCP is biologically and clinically relevant in UC and can be used as a biomarker in IBD.

Predictors of Complicated Disease Course in Children andAdults With Ulcerative Colitis: A Nationwide Study From the epi-IIRN.

Data on predictors of complicated ulcerative colitis (UC) course from unselected populations cohorts are scarce. We aimed to utilize a nationwide cohort to explore predictors at diagnosis of disease course in children and adults with UC. Data of patients diagnosed with UC since 2005 were retrieved from the nationwide epi-IIRN cohort. Complicated disease course was defined as colectomy, steroid-dependency, or the need for biologic drugs. Hierarchical clustering categorized disease severity at diagnosis based on complete blood count, albumin, C-reactive protein and erythrocyte sedimentation rate (ESR), analyzed together. A total of 13 471 patients with UC (1427 [11%] pediatric-onset) including 103 212 person-years of follow-up were included. Complicated disease course was recorded in 2829 (21%) patients: 1052 (7.9%) escalated to biologics, 1357 (10%) experienced steroid-dependency, and 420 (3.1%) underwent colectomy. Probabilities of complicated disease course at 1 and 5 years from diagnosis were higher in pediatric-onset (11% and 32%, respectively) than adult-onset disease (4% and 16%; P < .001). In a Cox multivariate model, complicated course was predicted by induction therapy with steroids (hazard ratio [HR], 1.5; 95% CI, 1.2-2.0), extraintestinal manifestations (HR, 1.3; 95% CI, 1.03-1.5) and the disease severity clusters of blood tests (HR, 1.8; 95% CI, 1.01-3.1), while induction therapy with enemas (HR, 0.6; 95% CI, 0.5-0.7) and older age (HR, 0.99; 95% CI, 0.98-0.99) were associated with noncomplicated course. In this nationwide cohort, the probability of complicated disease course during the first 5 years from diagnosis was 32% in pediatric-onset and 16% in adults with UC and was associated with more severe clusters of routinely collected laboratory tests, younger age at diagnosis, extraintestinal manifestations, and type of induction therapy.

Management of inflammatory bowel disease in the emergency setting: the MIBODI international survey and evidence-based practices.

This study aimed to evaluate the impact of the WSES-AAST guidelines in clinical practice and to investigate the knowledge, attitudes, and practices of emergency surgeons in managing the complications of ulcerative colitis (UC) and Crohn's disease (CD). The MIBODI survey is a cross-sectional study among WSES members designed as an international web-based survey, according to the Checklist for Reporting Results of Internet E-Surveys, to collect data on emergency surgeons' knowledge, attitudes, and practices concerning the management of patients presenting with acute complications of CD and UC. The questionnaire was composed of 30 questions divided into five sections: (1) demographic data, (2) primary evaluation, (3) non-operative management, (4) operative management, and (5) perianal sepsis management. Two hundred and forty-two surgeons from 48 countries agreed to participate in the survey. The response rate was 24.2% (242/1000 members on WSES mail list). Emergency surgeons showed high adherence to recommendations for 6 of the 21 assessed items, with a "correct" response rate greater than or equal to 60%, according to WSES-AAST recommendations. Nine critical issues were highlighted, with correct answers at a rate of less than 50%. Inflammatory bowel disease is a complex disease that requires a multidisciplinary approach with close collaboration between gastroenterologists and surgeons. Emergency surgeons play a crucial role in managing complications related to IBD. One year after publication, the MIBODI study showed significant global implementation of the WSES-AAST guidelines in clinical practice, offering an imperative tool in the improved management of IBD in emergency and urgent settings.

Diagnostic Utility of Cytomegalovirus (CMV) DNA Quantitation in Ulcerative Colitis.

Cytomegalovirus (CMV) colitis is a critical condition associated with severe complications in ulcerative colitis (UC). This study aimed to investigate the diagnostic value of the presence of CMV DNA in intestinal mucosa tissue and blood samples in patients with active UC. This study included 81 patients with exacerbated symptoms of UC. Patient data were obtained from the Hospital Information Management System. CMV DNA in colorectal tissue and plasma samples were analyzed using a real-time quantitative PCR assay. CMV markers were detected using immunohistochemistry and hematoxylin-eosin staining. Immunohistochemistry positivity was observed in tissue samples from eight (9.9%) patients. Only one (1.2%) patient showed CMV-specific intranuclear inclusion bodies. CMV DNA was detected in 63.0% of the tissues (median: 113 copies/mg) and in 58.5% of the plasma samples (median: 102 copies/mL). For tissues, sensitivity and the negative predictive value (NPV) for qPCR were excellent (100.0%), whereas specificity and the positive predictive value (PPV) were low (41.9% and 15.7%, respectively). For plasma, sensitivity and NPV were high (100.0%) for qPCR, whereas specificity and PPV were low (48.6% and 24.0%, respectively). CMV DNA ≥392 copies/mg in tissue samples (sensitivity 100.0% and specificity 83.6%) and ≥578 copies/mL (895 IU/mL) in plasma samples (sensitivity 66.7% and specificity 100.0%) provided an optimal diagnosis for this test. The qPCR method improved patient management through the early detection of CMV colitis in patients with UC. However, reliance on qPCR positivity alone can lead to overdiagnosis. Quantification of CMV DNA can improve diagnostic specificity, although standardization is warranted.

Myositis as a de-novo extraintestinal manifestation of ulcerative colitis in a pediatric patient developing post-colectomy: a case report

This report presents the case of a 13-year-old female with a history of ulcerative colitis who underwent ileostomy closure after total colectomy. Postoperatively, she developed right leg paresis and extensive swelling of the lower extremities. Imaging investigations revealed myositis with avascular necrosis in the distal femoral condyles. These findings were consistent with myositis as an extraintestinal complication of ulcerative colitis.

P366 Risk factors and outcomes of chronic antibiotic-refractory pouchitis in Korean ulcerative colitis patients: a single center retrospective study

Abstract Background Chronic inflammation of the pouch after total proctocolectomy with ileal pouch-anal anastomosis (IPAA) remains a morbid complication in ulcerative colitis (UC). The goal of this study was to investigate risk factors and clinical outcomes of chronic antibiotic-refractory pouchitis (CARP) in Korean patients with UC. Methods This was a single center retrospective study on patients with UC who underwent total proctocolectomy with IPAA at Asan Medical Center in Korea between January 1987 and December 2022. CARP was defined as failure to respond to a 4-week course of a single antibiotic, needing more than 4 weeks of therapy with 5-aminosalicylates, steroids, immunomodulators or biologics/small molecules, while chronic antibiotic-dependent pouchitis (CADP) was defined as more than 3 episodes of pouchitis per year or persistent symptoms requiring long-term antibiotics to maintain disease remission. Primary outcomes were endoscopic remission defined as complete mucosal healing of chronic pouchitis and pouch failure defined as the requirement of diverting loop ileostomy or pouch excision. Univariable and multivariable logistic regression analysis were used to identify risk factors of CARP. Results A total of 251 patients were included and 232 were analyzed (Male, 57.3%; Current smoker, 13.4%; Median age at surgery, 44 years; Disease duration at surgery, 4 years; Previous exposure to biologics/small molecules, 23.7%; Extra-intestinal manifestations, 8.2%; Preoperative cytomegalovirus infection, 19.4%). The most common cause of surgery was steroid refractoriness (50.9%), followed by dysplasia/colorectal cancer (26.7%). The median time from surgery to chronic pouchitis was 48 months (interquartile range 23.5–100.0). Among 74 patients (31.9%) with chronic pouchitis, 31 patients (13.4%) were CARP and 43 patients (18.5%) were CADP. The most frequent endoscopic phenotype according to Chicago classification was focal inflammation of the pouch in all groups (chronic pouchitis, 47.3%; CARP, 35.5%; CADP, 55.8%). Patients with CARP were less likely to have concomitant probiotics compared with CADP (29.0% vs 72.1%; p&amp;lt;0.01). Endoscopic remission rate in chronic pouchitis, CARP, and CADP were 14.9% (11/74), 9.7% (3/31), and 18.6% (8/43), respectively (Table 1). Pouch failure rate in chronic pouchitis, CARP, and CADP were 13.5% (10/74), 16.1% (5/31), and 11.6% (5/43), respectively (Table 1). In a multivariable analysis, current smoking status was positively associated with CARP development (OR: 3.56; 95% confidence interval 1.33–9.52; p=0.01). Conclusion Current smoker with UC who underwent IPAA had a higher risk of CARP. Concomitant use of probiotics was less likely to be associated with developing CARP.

A clinical case of early multifocal atherosclerosis complicated by acute coronary syndrome in a young man with ulcerative colitis

Inflammatory bowel disease (IBD) is a chronic, relapsing, systemic and immune-mediated conditiondis that frequently involve extraintestinal manifestations. Latest studies showed increased risk of cardiovascular complications, which is the main cause of death in developed countries, in chronic inflammatory disorders, especially during IBD relapses. IBD patients are at increased risk of conditions such as early atherosclerosis, ischaemic heart disease, myocardial infarction, stroke, venous thrombosis, heart failure, аtrial fibrillation. Hypotheses for the mechanism underlying the association of IBD and atherosclerotic cardiovascular diseases include adverse effects of both the IBD itself (chronic inflammation, еndothelium dysfunction, dyslipidemia, thrombocytosis, gut microbiome dysfunction) and its treatment. The predominant role in atherogenesis is currently assigned to disruption of the endothelium. Endothelium plays an important role in physiologic regulation of vascular tone, cell adhesion, migration and resistance to thrombosis. Also, its dysfunction is associated with increased risk of atherosclerosis development. Early multifocal atherosclerosis is a serious complication of ulcerative colitis and can occur in young people without traditional cardiovascular risk factors. Untimely diagnosis, lack of pathogenetic treatment, correction of basic anti-inflammatory therapy and comprehensive consideration of a problem of high cardiovascular risk can lead to acute myocardial infarction and stroke and disability of a patient of working age. The authors present a case report of multifocal atherosclerosis complicated by acute coronary syndrome in a young man with ulcerative colitis, who required a radical revision of the therapy.

Differences in Management and Outcomes of Older and Younger Adults with Acute Severe Ulcerative Colitis.

Older adults with ulcerative colitis [UC] have greater morbidity than younger adults. The goal of this study was to investigate differences in the management and outcomes of older and younger patients hospitalised with severe UC. We conducted a retrospective cohort study of patients hospitalised for acute severe ulcerative colitis requiring intravenous steroids. We compared outcomes of adults aged ≥65 years with outcomes of younger patients. Primary study outcomes included frequency and timing of medical and surgical rescue therapy during the hospitalisation, postoperative complications, frailty, and mortality outcomes up to 1 year following the hospitalisation. Our cohort included 63 older adults [≥65 years] and 137 younger adults [14-64 years]. Despite similar disease severity at hospitalisation, older adults were half as likely to receive medical rescue therapy (odds ratio 0.45, 95% confidence interval [CI] 0.22-0.91). This difference was more striking among the frailest older adults. Older patients were similarly likely to undergo surgery but were more likely to undergo urgent or emergent procedures [50%] compared with younger patients [13%] [p <0.004]. The fraction of older adults at high risk for frailty increased from 33% pre-hospitalisation to 42% post-hospitalisation. Nearly one-third [27.8%] of older adults died within 1 year of hospitalisation, with half the deaths among older adults being attributable to UC or complications of UC. In comparison with younger patients, older adults had lower frequency use of medical rescue therapy, higher rates of emergency surgery, and increased mortality within 1 year. Further research is needed to optimise care pathways in this population.

Bickerstaff’s brainstem encephalitis: a rare case of neurologic complication in Ulcerative Colitis

Bickerstaff’s brainstem encephalitis is a rare autoimmune disorder that presents with ataxia, ophthalmoplegia, disturbance of consciousness and quadriplegia. A 45-year-old man with a history of ulcerative colitis (UC) taking mesalazine (5-aminosalicylic acid) visited the emergency room presenting with ataxia, ophthalmoplegia and a progressively worsening cognitive impairment. Cerebrospinal fluid analysis showed mild elevation in protein and white blood cell count and increased intracranial pressure. Anti-GQ1b autoantibodies were found positive in the patient’s serum and contrast-enhanced brain magnetic resonance imaging showed diffuse leptomeningeal enhancement and pontine lesions. Based on these findings and the patient’s clinical course and history, he was diagnosed with Bickerstaff’s brainstem encephalitis. Mesalazine was discontinued and high-dose steroid pulse therapy was started, followed by intravenous immunoglobulin, which resulted in gradual improvement of the neurologic symptoms. When an ulcerative colitis patient presents with progressive cognitive impairment, quadriplegia and disturbance of consciousness and gait, Bickerstaff brainstem encephalitis should be considered in the differential diagnosis and prompt immunotherapy may lead to favorable prognosis.

Radical surgery for non-neoplastic colonic diseases

Aim. To improve the results of surgical treatment for patients with non-neoplastic colonic diseases by optimizing the choice of radical surgery extent. Materials and methods. The study material was the analysis of radical surgical interventions performed in 87 patients with non-neoplastic colonic diseases: ulcerative colitis, Crohn’s disease, familial adenomatous polyposis, chronic colonic and coloproctogenic stasis, diverticular colon disease. The age of the operated patients was 20–72 years. There were 49 (56.3 %) men and 38 (43.7 %) women. The criteria for choosing the radical surgery extent for these diseases were defined and substantiated. Results. There were 3 postoperative mortalities (3.4 %) among patients operated on absolute indications for acute complications of ulcerative colitis and Crohn’s disease. Recurrences of ulcerative colitis, Crohn’s disease and familial adenomatous polyposis occurred in 16 (18.4 %) operated patients in the area of the retained rectal stump and terminal ileum. Malignant transformation of the rectal stump occurred in 5 (5.7 %) patients with these recurrences. The extent of radical surgery in non-neoplastic colonic diseases depended on the diagnosis of the underlying disease, the presence of complications, the depth of wall lesions and the extent of the pathological process, the risk of recurrence in the anatomical parts of the small and large intestine. Conclusions. Deciding on the extent of the radical stage of surgical intervention depended on the diagnosis, features of the clinical course of non-neoplastic colorectal diseases, recurrences, the general condition of a patient, the pathological process extent and severity. Performing the optimal extent of radical surgery for non-neoplastic colonic diseases helped reduce the number of recurrences in the terminal part of the small intestine to 4 (4.6 %), in the area of the rectal stump to 7 (8.1 %), improved functional outcomes and quality of life in 76 (87.3 %) operated patients.

Regulation of inflammatory macrophages by oral mineralized metal-organic framework nanoparticles for the synergistic treatment of ulcerative colitis and liver injury

The exacerbation of liver injury has been identified as a severe complication of ulcerative colitis (UC), due to its ability to trigger a systemic inflammatory response. The aggravation of both ulcerative colitis and liver injury is primarily attributed to the presence of inflammatory macrophages, which exhibit elevated expression of tumor necrosis factor alpha (TNF-α). Considerable efforts are being devoted to the development of drugs capable of effectively inhibiting TNF-α expression in inflammatory macrophages, with the aim of mitigating the severity of this complex disease. Glutathione (GSH) suppressed inflammation by neutralizing reactive oxygen species (ROS) and mitigating cellular damage. In this study, we designed biomimetic mineralized metal–organic framework nanoparticles encapsulating siTNF-α and GSH (ZIF-8/siTNF-α/GSH@CaCO3, ZTGC) for the purpose of reprogramming inflammatory macrophages. In this study, we verified the co-occurrence of ulcerative colitis and liver injury. The calcium carbonate present in ZTGC provided protection against degradation in the gastrointestinal environment, facilitating effective and sustained release of siTNF-α in inflammatory macrophages. Oral administration of ZTGC mitigated ulcerative colitis, ameliorated liver injury, and diminished systemic inflammation in vivo. These findings suggest that mineralized metal–organic framework nanoparticles have the potential to serve as an effective oral administration for the synergistic treatment of inflammatory diseases. This innovative approach provides new insights into the “two in one” treatment of these complications.

Rapidly evolving gangrenous vasculitis in a critically ill patient with ulcerative colitis: a case report

Ulcerative colitis is a disease characterised by non-granulomatous submucosal inflammation ranging from isolated proctitis to colitis. Extra-intestinal manifestations of the condition occur in multiple organ systems, with dermatological complications occurring commonly. This case report aims to highlight an uncommon dermatological complication of ulcerative colitis with particular focus on patient care and management.

Roles of macrophages on ulcerative colitis and colitis-associated colorectal cancer.

Colitis-associated colorectal cancer is the most serious complication of ulcerative colitis. Long-term chronic inflammation increases the incidence of CAC in UC patients. Compared with sporadic colorectal cancer, CAC means multiple lesions, worse pathological type and worse prognosis. Macrophage is a kind of innate immune cell, which play an important role both in inflammatory response and tumor immunity. Macrophages are polarized into two phenotypes under different conditions: M1 and M2. In UC, enhanced macrophage infiltration produces a large number of inflammatory cytokines, which promote tumorigenesis of UC. M1 polarization has an anti-tumor effect after CAC formation, whereas M2 polarization promotes tumor growth. M2 polarization plays a tumor-promoting role. Some drugs have been shown to that prevent and treat CAC effectively by targeting macrophages.

P273 Severity of colitis and clinical outcomes for patients admitted with acute UC in 2 large UK centres

Abstract Background Acute severe ulcerative colitis (ASUC) is a challenging complication of ulcerative colitis (UC) that can result in colectomy and even death. Management and recognition of the condition is based on criteria that have changed little since the 1950s (Truelove and Witts criteria). Patients may be admitted to hospital with acute colitis that does not meet criteria to be classed as severe. We hypothesised that such patients might be at risk of “over-management” if treated according to standard ASUC pathways. Methods We performed a retrospective review of inpatients managed for acute UC flares in two UK tertiary centres. We collected their baseline and outcome data. We assessed the proportion of patients meeting criteria for severe disease and compared outcomes between severe and non-severe groups. Results A total of 243 admissions for 200 unique patients were identified for analysis. A formal documentation of disease severity according to Truelove and Witts criteria was present in only 10/243 (4%). 121/243 (50%) met formal criteria for severe disease. Baseline demographic and disease characteristics were similar between patients with severe and non-severe disease (table-1). The use of rescue therapy was more common in the severe group (48% vs 34%, p=0.032). All other outcomes, including hospital length of stay, colectomy rates, and need for readmission were comparable (table-2). Conclusion Patients admitted for acute colitis may frequently not meet criteria for severe disease. It is possible that earlier discharge or admission avoidance may be possible for this group. Baseline demographics do not appear to identify patients with less severe symptoms who nonetheless get admitted. Although rescue therapy was less common for non-severe patients, other outcomes were comparable, including length of stay and colectomy rates. There is a risk that once admitted, non-severe patients may receive management according to standard algorithms for severe disease, risking overtreatment for a subgroup of patients.