In primary care, management of mild to moderate ulcerative colitis involves excluding alternative causes for symptoms such as infection or drug effects, and managing symptoms accordingly NICE CKS.
For mild to moderate disease, treatment options include topical aminosalicylates for proctitis or left-sided colitis, and oral aminosalicylates, possibly combined with topical therapy, to induce remission NICE CKS.
If remission is not achieved within 4 weeks, consider adding a time-limited course of corticosteroids, either topical or oral NICE CKS.
Management also includes advising on diet, hydration, and symptom management, and seeking specialist advice if symptoms persist or worsen NICE CKS.
In cases of recurrent flares, primary care should refer to specialist services for further assessment and management, including consideration of escalation to immunomodulators or biological therapies as appropriate NICE CKS.