On the Bleeding Edge: Mastering GI Emergencies and Inpatient GI Consultation (Live and Virtual)| September 2026-RUBIN ASUC IBD v4'-On the Bleeding Edge-GI Emergencies

RUBIN ASUC IBD v4'-On the Bleeding Edge-GI Emergencies

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This presentation reviews the modern medical management of acute severe ulcerative colitis (ASUC), emphasizing early recognition, careful inpatient monitoring, and timely escalation to surgery when needed. ASUC is a medical emergency marked by severe diarrhea, bleeding, urgency, anemia, dehydration, toxic dilatation, perforation risk, or failure of outpatient therapy. Hospitalization should prompt immediate surgical consultation, stopping opioids/anticholinergics/NSAIDs and 5-ASA, starting venous thromboembolism prophylaxis, and ruling out infections such as C. difficile and CMV.<br /><br />Initial treatment includes resuscitation with IV fluids and transfusion when appropriate, plus treatment of concomitant infections while continuing colitis therapy. Standard induction options for ASUC include IV corticosteroids, infliximab, cyclosporine, and in selected cases JAK inhibitors. Infliximab and cyclosporine remain key rescue therapies after steroid failure, though response may be limited by factors such as low albumin and high drug clearance. JAK inhibitors, especially tofacitinib and upadacitinib, are promising but not yet standard for all hospitalized patients because supporting data remain limited and safety concerns persist.<br /><br />The talk highlights tools to predict steroid failure early, including clinical indices, endoscopy, biomarkers, and intestinal ultrasound. Response should be assessed quickly, usually within 3 to 7 days, to avoid delay in rescue therapy or surgery.<br /><br />Long-term success depends on a clear monitoring and maintenance plan, including steroid-free follow-up, therapeutic drug monitoring, and serial disease assessment with biomarkers, endoscopy, or imaging. Finally, surgery should not be delayed too long: elective or staged colectomy is safer and often better than urgent surgery after prolonged medical failure.

Keywords

acute severe ulcerative colitis

ASUC

hospitalization

IV corticosteroids

infliximab

cyclosporine

JAK inhibitors

steroid failure

therapeutic drug monitoring

colectomy