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Original Article
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- Clinical spectrum of acute severe ulcerative colitis in the biologic era: a prospective cohort study from India
- Arshdeep Singh, Mayur Luthra, Arshia Bhardwaj, Ramit Mahajan, Riya Sharma, Dharmatma Singh, Devanshi Jain, Omesh Goyal, Varun Mehta, Kirandeep Kaur, Yogesh Kumar Gupta, Vandana Midha, Ajit Sood
- Intest Res 2026;24(2):236-247. Published online June 9, 2025
- DOI: https://doi.org/10.5217/ir.2024.00189
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Abstract
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Supplementary Material
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ePub - Background/Aims
Acute severe ulcerative colitis (ASUC) is a time-critical situation requiring urgent intervention. Limited data exist on the evolving clinical spectrum of ASUC in the era of advanced therapies.
Methods
This prospective real-world observational cohort study included 145 adult patients hospitalized with ASUC between January 2020 and June 2024. ASUC was defined by the modified Truelove and Witts criteria. Demographics and disease characteristics, including disease severity, probable precipitating factors, and corticosteroid failure rates, were recorded.
Results
The median age of patients was 36 years (interquartile range, 26–48.5 years) with 63 females (43.4%). Most patients had left-sided colitis (53.1%). The median disease duration was 1 year (IQR, 0.5–3 years), with 91 patients (62.7%) presenting with ASUC within the first year of diagnosis of ulcerative colitis. One-third of the patients had previous exposure to biologics and small molecules. The most commonly reported probable precipitants of ASUC were poor compliance with treatment (n = 43, 29.6%), antibiotic use (n = 35, 24.1%), high perceived stress (n = 32, 22.1%), and Clostridioides difficile infection (n = 19, 13.1%). Forty patients (27.5%) were non-responders to intravenous corticosteroids (IVCS). Twenty-nine patients (20%) received medical rescue therapy (infliximab, n = 14 [48.27%], cyclosporine A, n = 6 [20.68%], and tofacitinib, n = 9 [31.03%]). Seven patients (4.82%; 4 after non-response to IVCS and 3 after non-response to medical rescue therapy) underwent colectomy.
Conclusions
In this cohort of ASUC patients, poor treatment compliance, antibiotic use, stress, and C. difficile infection were common precipitants of flare-ups. Nearly one-third of patients required medical rescue therapy, and a small proportion ultimately underwent colectomy. -
Citations
Citations to this article as recorded by
- Effectiveness and Safety of Janus Kinase Inhibitors in Acute Severe Ulcerative Colitis: A Systematic Review and Meta-Analysis
Anuraag Jena, Abhirup Chatterjee, Arup Choudhury, Vishal Sharma, Shaji Sebastian
Clinical Gastroenterology and Hepatology.2026;[Epub] CrossRef - Is Clostridioides difficile superinfection a major causative factor for acute flares associated with moderate to severe ulcerative colitis in northern India?
Hitesh Panchal, Sukrit Sud, Rajesh Puri, Sonam Singla, Amarender S. Puri
Indian Journal of Gastroenterology.2026;[Epub] CrossRef - Clostridioides difficile infection in inflammatory bowel disease: an observational study in flares of ulcerative colitis and a South Asian region-specific systematic review and meta-analysis
Deepak Bansal, Sapna Pahil, Abhirup Chatterjee, Simran Kaur, Harshal S. Mandavdhare, Jimil Shah, Vaneet Jearth, Aravind Sekar, Sandeep Raut, Harjeet Singh, Sahil Khanna, Saroj Kant Sinha, Neelam Taneja, Usha Dutta, Vishal Sharma
Therapeutic Advances in Gastroenterology.2026;[Epub] CrossRef - Distinct predictive factors for acute severe ulcerative colitis in East Asian and Western populations
Eun Soo Kim, Dong Hyun Kim, Seong-Jung Kim, Sang Hyoung Park, Hyun Seok Lee, Sung Kook Kim, Hyun Soo Kim, Jun Lee, Kyeong Ok Kim, Byung Ik Jang, Yoo Jin Lee, Eun Mi Song, Dae Sung Kim, Chun-Chi Lin, Joyce Wing Yan Mak, Jing Liu, Qian Cao, Shu-Chen Wei, We
Inflammatory Bowel Diseases.2026;[Epub] CrossRef - The JAK attack: transforming the management of ulcerative colitis in India
Arshdeep Singh, Arshia Bhardwaj, Vandana Midha, Ajit Sood
Intestinal Research.2026; 24(3): 392. CrossRef
- Effectiveness and Safety of Janus Kinase Inhibitors in Acute Severe Ulcerative Colitis: A Systematic Review and Meta-Analysis
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