Intestinal Research

Original Article

A survey on the practices and patterns in the management of acute severe ulcerative colitis in India: Arshia Bhardwaj, Arshdeep Singh, Riya Sharma, Vandana Midha, Ajit Sood; Received April 21, 2025 Accepted August 18, 2025 Published online November 14, 2025; DOI: https://doi.org/10.5217/ir.2025.00060 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
The real-world management of acute severe ulcerative colitis (ASUC) varies considerably across regions and healthcare settings. This study aimed to evaluate current management practices for ASUC among gastroenterologists in India.
Methods
A structured, web-based survey covering 5 thematic domains (provider and institutional characteristics, clinical workload and initial management, diagnostic practices, infectious work-up, and strategies for rescue therapy) was disseminated via email. Responses were analyzed using descriptive statistics.
Results
A total of 228 responses were received from across India’s 5 geographic zones. The majority of respondents were affiliated with either corporate hospitals (n = 76, 33.3%) or teaching hospitals (n = 68, 29.8%). The majority (n = 135, 59.2%) reported managing up to 10 ASUC cases annually. The Truelove and Witts criteria were the most commonly used for diagnosis (n = 169, 74.1%). Nutritional assessment was performed by 89 respondents (39.0%). Biopsies for cytomegalovirus during index sigmoidoscopy were obtained by 75 (32.9%). Intravenous hydrocortisone was the preferred steroid (n = 188, 82.5%). Low molecular weight heparin for thromboprophylaxis was never prescribed by 62 respondents (27.2%). Oxford criteria were most frequently used to assess steroid response (n = 150, 65.8%). More than half of the respondents (n = 125, 54.8%) reported that fewer than 50% of patients accepted rescue therapy. Rescue therapy was initiated on or after day 5 by 153 respondents (67.1%). Early involvement of colorectal surgeons was reported by 66 (28.9%). A majority (n = 200, 87.7%) were associated with low-volume centers for ileal pouch-anal anastomosis, performing < 5 procedures per year.
Conclusions
This nationwide survey reveals considerable heterogeneity in ASUC management in India. Standardizing care through patient and healthcare provider education and context-specific guidelines is imperative.

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Review

IBD

What to do when traditional rescue therapies fail in acute severe ulcerative colitis: Christopher F. D. Li Wai Suen, Matthew C. Choy, Peter De Cruz; Intest Res 2024;22(4):397-413. Published online May 16, 2024; DOI: https://doi.org/10.5217/ir.2024.00003

Abstract PDF PubReader ePub

Acute severe ulcerative colitis (ASUC) is a medical emergency that affects approximately 25% of patients with ulcerative colitis at some point in time in their lives. Outcomes of ASUC are highly variable. Approximately 30% of patients do not respond to corticosteroids and up to 50% of patients do not respond to rescue therapy (infliximab or cyclosporin) and require emergency colectomy. Data are emerging on infliximab dosing strategies, use of cyclosporin as a bridge to slower acting biologic agents and Janus kinase inhibition as primary and sequential therapy. In this review, we outline contemporary approaches to clinical management of ASUC in the setting of failure to respond to traditional rescue therapies.

Citations

Citations to this article as recorded by

Early Infliximab Levels and Clearance Predict Outcomes After Infliximab Rescue in Acute Severe Ulcerative Colitis: Results From PREDICT-UC
Christopher F.D. Li Wai Suen, Matthew C. Choy, Danny Con, Kaylene Cheng, Julie Nigro, Kerry Breheney, Kristy Boyd, Raquel Pena, Kathryn Burrell, Ourania Rosella, David Proud, Richard Brouwer, Alexandra Gorelik, Danny Liew, William R. Connell, Emily K. Wri
Gastroenterology.2026; 170(1): 118. CrossRef
Optimal use and cycling strategies of Janus kinase inhibitors in ulcerative colitis: current evidence and clinical implications from the KASID Guidelines Task Force Team
Seung Min Hong, Dong Hyun Kim, June Hwa Bae, Seung Yong Shin, Eun Mi Song, Ji Eun Kim, Young Joo Yang, Jiyoung Yoon, Sang-Bum Kang, Eun Soo Kim, Seong-Eun Kim, Seong-Jung Kim, Jun Lee, Soo-Young Na, Soo Jung Park, Sang Hyoung Park, Miyoung Choi, Myung Ha
Intestinal Research.2026; 24(1): 27. CrossRef
Monocyte Distribution Width Differentiates Bacterial Enterocolitis from Acute Severe Ulcerative Colitis in the Emergency Department
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Digestive Diseases and Sciences.2026;[Epub] CrossRef
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The Lancet Gastroenterology & Hepatology.2025; 10(1): 19. CrossRef
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Therapeutic Advances in Gastroenterology.2025;[Epub] CrossRef
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Joo Hye Song, Sung Noh Hong, Myeong Gyu Kim, Minjung Kim, Seong Kyung Kim, Eun Ran Kim, Dong Kyung Chang, Young-Ho Kim
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Recent Advances in the Management of Acute Severe Ulcerative Colitis
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Journal of Clinical Medicine.2024; 13(23): 7446. CrossRef

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