skip to main content

Acute Severe Ulcerative Colitis — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardGastroenterology & HepatologyAcute Severe Ulcerative ColitisRACP Adult Medicine

A 25-year-old man presents with acute severe ulcerative colitis (bloody diarrhoea >6 times/day, pulse 110 bpm, CRP 85 mg/L). He has been admitted and commenced on IV hydrocortisone 100 mg QID. After 3 days, he continues to have 8 bloody stools per day with CRP 65 mg/L. What is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Commence infliximab

Failure to respond to 3 days of IV corticosteroids in acute severe UC (Travis criteria) defines steroid-refractory disease. Rescue therapy with infliximab (5 mg/kg IV) or IV ciclosporin are the options to avoid colectomy. Infliximab is increasingly preferred due to ease of use, established long-term maintenance data, and non-inferiority shown in the CONSTRUCT trial. If no response to rescue therapy within 4–7 days, colectomy should be considered.

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