skip to main content

Biologic selection in ulcerative colitis — ESEGH MCQ

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

HardGI PharmacologyBiologic selection in ulcerative colitisESEGH

A 78-year-old man with steroid-dependent ulcerative colitis has recurrent chest infections and a previous melanoma excised 4 years ago. Colonoscopy shows moderate left-sided colitis and stool cultures are negative. He is frail and wants a treatment with lower systemic immunosuppressive exposure if possible. What is the most appropriate management?

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

Reveal the answer and explanation

Correct answer: A — Vedolizumab after IBD MDT discussion

Vedolizumab is gut-selective and is often considered when systemic infection risk or malignancy history makes treatment selection nuanced. Long-term systemic steroids cause major harm and are not maintenance therapy. Combination anti-TNF and thiopurine may be effective but carries broader immunosuppressive risk. The pearl is that biologic choice should be individualised rather than purely efficacy-ranked.

Reference: BSG IBD Guideline 2025; BNF Vedolizumab