Patient handout

Ulcerative Colitis

PRODUCTION

1. Your condition

This handout is for ulcerative colitis. Your care team identified this based on: bloody diarrhea ± urgency / tenesmus.

Other reasons your team may use this plan: chronic rectal bleeding / mucous in stool; severe flare with systemic toxicity (truelove-witts); elevated fecal calprotectin / crp.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
mesalamine_oral	4-4.8 g PO daily (single dose preferred for adherence)	PO	daily	ACG 2025 — first-line for mild-moderate UC; high-dose preferred (≥3 g/day)
mesalamine_rectal	1 g PR enema or 1 g suppository daily	PR	daily	Topical superior to oral for proctitis; combined topical+oral best for left-sided
sulfasalazine	500 mg PO QID titrated to 4 g/day	PO	QID	Useful in UC + arthropathy; folate supplementation

Plan: Ulcerative colitis — Truelove-Witts severity-driven induction + advanced therapy maintenance (ACG 2025 + AGA 2024 living + ECCO)

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — In remission — continue maintenance

If you have:

Stable bowel pattern (≤3 BMs/day, formed, no blood)
No urgency, tenesmus
Normal energy
Calprotectin <250 (if measured)

Do this:

Take maintenance therapy as prescribed (5-ASA, biologic, immunomodulator)
No NSAIDs
Keep IBD clinic appointments
CRC surveillance per plan
Annual labs

YELLOW — Caution — early flare, contact IBD team within 24-48 hours

If you have:

Increased BMs (>4-5/day)
New blood in stool
New urgency or tenesmus
Mild fatigue or anorexia
Mild low-grade fever

Do this:

Continue maintenance therapy + add topical 5-ASA (1 g PR daily) if proctitis-prone
Hydrate
Stool sample for C. diff if available
Contact IBD team within 24-48 hours

Call your provider if:

Symptoms worsening despite home measures
Significant blood in stool
New fever
Weight loss

RED — Medical alert — go to ED now

If you have:

≥6 bloody BMs/day with systemic symptoms (fever >37.8, HR >90, fatigue)
Severe abdominal pain or distension
Vomiting, rigid abdomen (perforation)
Massive hemorrhage
Severe lightheadedness
Confusion

Do this:

Call 911 / go to nearest ED immediately
Bring updated medication list
Notify IBD team

Call your provider if:

Any red zone symptom — ED now, do not wait

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

≥6 bloody BMs/day + ≥1 systemic toxicity (T>37.8, HR>90, Hgb<10.5, ESR>30, CRP>30) (ACG 2019)
Transverse colon >5.5 cm on AXR + systemic toxicity in active colitis (ACG 2019)(life-threatening)
CRP >45 OR ≥8 stools/day OR 3-8 stools + CRP >45 at day 3 of IV steroid (Travis Gut 1996)
Positive CMV PCR/biopsy in steroid-refractory ASUC (ACG 2019)
Massive lower GI hemorrhage OR free air on imaging (ACG 2019)(life-threatening)

5. Follow-up

Post-induction 8-12w; maintenance q3-6mo stable; flare urgent <1w; ASUC daily inpatient; post-colectomy surgical follow-up; CRC surveillance; preconception counselling

6. Sources

Guideline: 2025 ACG UC Guideline (Rubin) + AGA 2024 Living Guideline (updated 2025) + ECCO 2022 Therapeutics + 2024 EIM update + NICE NG130 (2025-2026) + LUCENT (mirikizumab) + TRUE NORTH (ozanimod) + ELEVATE UC 52/12 (etrasimod) + U-ACHIEVE/U-ACCOMPLISH (upadacitinib) + UNIFI (ustekinumab) + OCTAVE (tofacitinib) + ACT 1/2 (infliximab) + VARSITY