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Ulcerative Colitis Flare — MRCP Part 1 MCQ

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HardGastroenterologyUlcerative Colitis FlareMRCP Part 1UKMLAPARA

A patient has a mild-to-moderate first presentation of left-sided ulcerative colitis without systemic toxicity. Which induction treatment should be offered first?

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Correct answer: A — Offer a topical aminosalicylate for up to 4 weeks

The best answer is “Offer a topical aminosalicylate for up to 4 weeks”. NICE offers topical aminosalicylate first line for mild-to-moderate proctosigmoiditis or left-sided disease. If remission is not achieved by 4 weeks, add high-dose oral aminosalicylate or switch to high-dose oral treatment plus a topical corticosteroid. Immediate combined oral and topical treatment is the first-line approach for extensive disease, while steroids, biologics and thiopurines occupy later roles.

Reference: NICE NG130, Ulcerative colitis: management: https://www.nice.org.uk/guidance/ng130/chapter/recommendations