Severe inflammatory bowel disease: medical management.

The majority of patients with inflammatory bowel disease (IBD) have mild or moderate disease. However, a minority have a severe attack requiring hospital admission. Acute severe colitis (ulcerative colitis and Crohn's colitis) continues to be a medical emergency requiring careful joint management by physicians and surgeons. Extensive Crohn's jejuno-ileitis can also present major management problems, particularly in children. The evidence base for the management of this potentially severe form of Crohn's disease is limited and thus treatment has to be largely tailor-made for individual cases. Acute intestinal failure occurs in Crohn's disease in a variety of clinical settings, but the most challenging problem in the acute phase is the management of the major losses of fluid and electrolytes.