1. Ulcerative Colitis Mild-Moderate Distal Colitis Mild-Moderate Extensive Colitis Severe Colitis Criteria for Evaluating the Severity of Ulcerative Colitis (Truelove & Witts) Topical 5-ASA AND/OR Oral 5-ASA Topical steroid OR Remission NO Oral steroids (prednisone) Maintenance (5-ASA) YES Oral 5-ASA + Topical 5-ASA Glucocorticoids (PO prednisone) YES Remission NO Maintenance Taper steroids YES NO +Azathioprine or 6-MP Failure Glucocorticoids (IV methylprednisone) R/O C.difficile Response after 7-10 days Maintenance (Azathioprine) IV Cyclosporine + Azathioprine NOYES Failure + infliximab exsanguination hemorrhages frank perforation carcinoma Surgery YES DEXA scan bisphosphonate calcium/VitD Consider in all patients Recurrent Symptoms? (steroid dependent) Surgery Failure + infliximab Failure Response & steroid sparing

2. Mild Moderate Severe Bowel Movements 6 per day Blood inSmallModerateSevere stool Fever None 37.5°C mean Tachycardia None 90 mean pulse Anemia Mild >75% < 75% Sedimentation 30 mm rate Truelove SC, Witts LJ. Cortisone in ulcerative colitis: Final report on a therapeutic trial. BMJ 1955;2:1041-8

3. Topical 5-ASA Rowasa Canasa Oral 5-ASA sulfasalazine Azulfidine mesalamine Lialda Dipentum Colazide Asacol Cortifoam or Cortenema, Colocort Topical steroids hydrocortisone AND/OR

4. Anti-TNF α infliximabadalimumab (Crohn’s only)