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Acute severe ulcerative colitis — SCE Acute Medicine MCQ

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HardGastroenterology and hepatologyAcute severe ulcerative colitisSCE Acute Medicine

A 28-year-old woman with acute severe ulcerative colitis has received intravenous hydrocortisone and thromboprophylaxis. On day 3 she still passes 9 bloody stools daily and CRP is 92 mg/L; abdominal radiography shows no perforation or megacolon. What is the most appropriate next step?

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Correct answer: D — Give rescue infliximab or ciclosporin with surgical assessment

More than 8 stools per day, or 3–8 stools with CRP above 45 mg/L on day 3, predicts a high likelihood of steroid failure. Rescue infliximab or ciclosporin should be considered promptly alongside colorectal surgical review. Azathioprine is too slow for rescue, and prolonging ineffective steroids increases complications and delays colectomy when it is needed.

Reference: https://www.nice.org.uk/guidance/ng130/chapter/recommendations