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Ulcerative Colitis — RACP Adult Medicine MCQ

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ModerateGastroenterology & HepatologyUlcerative ColitisRACP Adult Medicine

A 35-year-old man presents with a 4-week history of bloody diarrhoea, urgency, and tenesmus. Colonoscopy shows continuous inflammation from the rectum extending to the splenic flexure with loss of vascular pattern and contact bleeding. Biopsies confirm ulcerative colitis. His Simple Clinical Colitis Activity Index score is 8. What is the most appropriate initial treatment?

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Correct answer: A — Mesalazine 4.8 g daily (oral) plus mesalazine enema

This patient has moderately active left-sided ulcerative colitis. First-line treatment is combined oral and topical (enema) mesalazine at high doses (oral 4–4.8 g/day). Topical therapy is important for left-sided disease. If inadequate response after 2–4 weeks, oral corticosteroids should be added. Budesonide MMX may be considered but standard budesonide has limited colonic activity.

Reference: eTG – 2025 – Gastrointestinal; ECCO – 2022 – UC Guidelines