• Anish J Kuriakose Kuzhiyanjal and Jimmy K Limdi.
• Digestive Diseases Unit, Aintree University Hospital, Lower Ln, Fazakerley, Liverpool L97AL, UK.
• Br. Med. Bull. 2024 Sep 27; 151 (1): 3153-15.

BackgroundAcute severe ulcerative colitis (ASUC) is a potentially life-threatening medical emergency that occurs in up to 25% of patients with ulcerative colitis. Although intravenous corticosteroids remain the cornerstone of therapy, 30-40% of patients will not respond and need timely consideration of rescue therapy with (currently) either infliximab or ciclosporin or indeed colectomy, underscoring the importance of multidisciplinary care to ensure favourable outcomes for patients. We discuss the current evidence and present an approach to the management of ASUC for general and specialist clinicians caring for patients with ASUC.Sources Of DataThe information in this review is derived from data published in peer- reviewed academic journals and registered clinical trials.Areas Of AgreementManagement of acute severe colitis requires a multidisciplinary approach with early initiation with steroids and timely escalation of treatment to either medical rescue therapy or surgery.Areas Of ControversyBalancing the risks of delayed surgery vs. optimizing medical therapy, including accelerated dosing schedules for biologics, remains ambiguous.Growing PointsThe position on newer molecules like Janus Kinase inhibitors, such as tofacitinib, is a growing area with early real-world data showing promise for steroid refractory ASUC.Areas Timely For Developing ResearchDeveloping predictive biomarkers and clinical risk scores for personalized rescue therapy selection is an evolving area of research.© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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