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Treatment by disease severity and location (based on ACG Practice Guidelines) Mild-moderate distal colitis Oral aminosalicylates, topical mesalamine, or topical steroids A combination of oral and topical aminosalicylates is better than either alone For refractory cases, oral steroids or IV infliximab can be used (though this is less well-studied in distal colitis) Mild-moderate extensive colitis Oral sulfasalazine 4-6 g/day or alternative aminosalicylate 4.8 g/day Oral steroids for patients refractory to the above therapy + topical therapy 6-MP or azathioprine for patients refractory to oral steroids, but not so severe as to require IV therapy Infliximab in patients who are steroid refractory/dependent on adequate doses of 6-MP/thiopurine or who are intolerant to these medications Severe colitis Infliximab if urgent hospitalization is not needed If a patient is toxic, should be admitted to the hospital for IV steroids Failure to improve in 3-5 days is an indication of colectomy or IV cyclosporine Maintenance 6-MP can also be added to these patients Indications for Surgery Absolute: Hemorrhage, perforation, documented or strongly suspected cancer Also, surgery is recommended for severe colitis refractory to medical therapy Are there any special dietary requirements for people with ulcerative colitis
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