Management of mild-to-moderate ulcerative colitis: patient guide

Clinical practice guidelines are developed under the guidance of the AGA Institute Clinical Guideline Committee and provide evidence-based recommendations for clinical practice in the field of gastroenterology. The clinical practice guidelines and related Clinical Decision Support Tools support evidence-based clinical decision-making by gastroenterologists and other health-care professionals at the point of care. The below information presents important content from those guidelines in a way that will help patients better understand AGA’s recommendations for evaluating, diagnosing or managing a condition.

AGA Clinical Practice Guidelines on the Management of Mild-to-Moderate Ulcerative Colitis

The information provided by the AGA Institute is not medical advice and should not be considered a replacement for seeing a medical professional.

What is ulcerative colitis?

  • Ulcerative colitis (UC) is a form of inflammatory bowel disease, or IBD that affects the large intestine.
  • In a person with UC, the lining of the colon becomes inflamed and swollen.
  • Symptoms:
    • Diarrhea (loose stool).
    • Bloody stool.
    • Belly pain and cramping.
    • Loss of appetite.
    • Weight loss.
    • Fatigue (low energy).
    • Anemia (low blood counts).
    • Joint pain.
    • Skin changes.
  • Untreated UC can lead to problems or other chronic conditions, such as:
    • Unpredictable flare-ups that causes bleeding in the stool, diarrhea and belly pain.
    • Severe dehydration (when the body is not receiving enough water to normally function).
    • Anemia due to blood loss and may need blood transfusion.
    • Higher risk of colon cancer if UC is not frequently monitored.

Mild-to-moderate vs moderate-to-severe ulcerative colitis

The severity of UC is classified as mild-to-moderate or moderate-to-severe.


Defined as individuals having fewer than 4-6 bowel movements a day with mild or moderate bleeding in the stool, fewer symptoms, and relatively mild inflammation in the colon and the rest of the body.

  • NOTE. Individuals within the mild-moderate spectrum that have more frequent bowel movements, more prominent bleeding in the stool, and greater inflammation in the colon are considered to have moderate UC.


Defined as individuals having frequent bloody stools more than 6 times per day with severe cramps and symptoms and more severe inflammation in the colon.

How do you get diagnosed with ulcerative colitis?

Common tests used in patients with UC are:

  • Colonoscopy: this is the test used most commonly to make the initial diagnosis of UC and later for ongoing monitoring of disease severity.
  • Routine blood tests: detect infection, anemia, inflammation and vitamin deficiencies.
  • Fecal blood test: detects blood in your stool and bleeding in the intestines.
  • Other stool tests: detect infection and monitor disease severity.
  • Computerized tomography (CT scan): shows different images of the bowels and surrounding tissue.

Types of drugs prescribed to treat mild-to-moderate ulcerative colitis

Many different types of medications can be used to treat mild-to-moderate ulcerative colitis. The right choice depends on the severity of inflammation and how much colon of the colon is inflamed.

  • Aminosalicylates (5-ASAs): these drugs are used to decrease inflammation in the lining of the intestines. They can be given as pills, suppositories, or enemas.
  • The 3 main 5-ASAs are:
    • Sulfasalazine.
    • Mesalamine.
    • Diazo-bonded ASA such as balsalazide or olsalazine.
  • Corticosteroids: these drugs are used to help decrease inflammation by suppressing the immune system. These medications should not be used chronically. Commonly used corticosteroids for this condition are prednisone and budesonide.
  • Individuals with extensive mild-to-moderate UC are given a dose of 2-3 grams of mesalamine a day or diazo-bonded 5-ASA to manage the symptoms.
  • Fecal microbiota transplantation (FMT, or a stool transplant) is a potential treatment that requires more research. It should only perform as research in clinical trials for patients with mild-to-moderate UC who do not have a Clostridium difficile (C. diff) infection.