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Steroid-refractory acute severe ulcerative colitis — ESEGH MCQ

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HardInflammatory Bowel DiseaseSteroid-refractory acute severe ulcerative colitisESEGH

A 31-year-old man is on day 3 of intravenous hydrocortisone for acute severe ulcerative colitis. He still opens his bowels 9 times daily with visible blood. CRP remains 112 mg/L and albumin is 26 g/L. Abdominal radiograph shows no perforation. Surgical review has occurred. What is the most important next step?

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Correct answer: D — Start rescue therapy with infliximab or ciclosporin after MDT discussion

Persistent frequent bloody stools and high CRP after 3 days of intravenous steroids indicate steroid-refractory ASUC, requiring timely rescue therapy or colectomy planning. Prolonging ineffective steroids increases perforation and infection risk. Mesalazine and loperamide do not address severe steroid-refractory inflammation. The pearl is that day-3 assessment prevents drift in ASUC management.

Reference: BSG IBD Guideline 2025; NICE Ulcerative Colitis Guideline