[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-458021-105":59,"doc-detail-458021-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","managing-acute-severe-ulcerative-colitis-in-2025-and-beyond","Managing Acute Severe Ulcerative Colitis in 2025 and Beyond","","Acute severe ulcerative colitis (ASUC) remains a high-risk, life-threatening presentation despite progress in diagnostics, prognostication, and treatments. This review synthesizes recent evidence to close care gaps by optimizing medical strategies that aim to reduce colectomy rates and improve patient outcomes. It highlights risk stratification using clinical, endoscopic, and biomarker data, discusses emerging biomarkers and predictive models, and evaluates new and intensified therapies.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/managing-acute-severe-ulcerative-colitis-in-2025-and-beyond/458021/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/managing-acute-severe-ulcerative-colitis-in-2025-and-beyond/458021.png","ImageObject",300,407,{"name":92,"@type":93},"Eliana","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-10","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What is the main clinical goal in managing acute severe ulcerative colitis (ASUC)?","Question",{"text":113,"@type":114},"Reduce high-risk outcomes by optimizing medical strategies to lower colectomy rates and improve patient outcomes, supported by rapid risk stratification.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"Which therapies are discussed as rescue options in ASUC?",{"text":118,"@type":114},"The review focuses on infliximab rescue and rescue strategies involving cyclosporine and upadacitinib, alongside emerging approaches such as Janus kinase inhibitors.",{"name":120,"@type":111,"acceptedAnswer":121},"Why is further research needed in ASUC management beyond 2025?",{"text":122,"@type":114},"Because best timing, sequencing, dosing, and positioning of newer agents relative to infliximab and cyclosporine are not yet established, and real-time dynamic decision thresholds remain limited.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},458021,1791096878,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":140,"language":141,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":142,"faqs":143,"seo_title":144,"seo_description":67,"update_tm":145,"read_time":146,"preview_page_count":4},4398048949847,"https://ap-avatar.wpscdn.com/avatar/400002536579ef2da7f?_k=1778318612642679267","Current Gastroenterology Reports (2026) 28:3 [https://doi.org/10.1007/s1](https://doi.org/10.1007/s1) 1894-025-01025-y  \nREVIEW  \nManaging Acute Severe Ulcerative Colitis in 2025 and Beyond  \nManjeet Kumar Goyal1 · Syed Adeel Hassan2 · Jeffrey Aaron Berinstein2  \nReceived: 8 April 2025 / Accepted: 31 October 2025 © The Author(s) 2026  \nAbstract  \nPurpose of Review Acute severe ulcerative colitis (ASUC) remains a high-risk condition with suboptimal clinical outcomes despite advancements in diagnostics, prognostication, and therapies. This review synthesizes recent evidence to address critical gaps in care, focusing on optimizing medical strategies to reduce colectomy rates and improve patient outcomes. Recent Findings Recent studies have identified novel biomarkers and predictive models for stratifying patients as high-risk for colectomy. Several emerging therapeutic strategies to optimize care have also been explored. Intensified infliximab dosing has not consistently shown improved clinical outcomes across all patients with ASUC, though it may benefit a subset of patients with unfavorable pharmacokinetics. Furthermore, Janus kinase inhibitors have shown promise in reducing colectomy rates, offering a potential alternative for select patients; however, supporting evidence remains preliminary. Despite these advancements, colectomy remains exceedingly common but continues to serve as a critical intervention to reduce complications and mortality. This underscores the therapeutic efficacy ceiling that still exists in our current approach to ASUC in 2025.  \nSummary Modern ASUC management prioritizes rapid risk stratification (using clinical, endoscopic, and biomarker data) and patient-tailored advanced therapy selection. Future strategies should focus on conducting rigorous trials of emerging agents in comparison to our current protocols, while integrating real-time, personalized, and dynamic prognostic tools to reduce heterogeneity in treatment response.  \nKeywords Acute severe ulcerative colitis · Ulcerative colitis · Hospitalization · Infliximab rescue · Cyclosporine rescue · Upadacitinib rescue · Colectomy.  \nIntroduction  \nAcute severe ulcerative colitis (ASUC) is a life-threatening presentation of ulcerative colitis (UC) that necessitates prompt initiation of inpatient medical treatment and assessment for surgical intervention [1, 2] . Despite substantial progress in diagnostic techniques, prognostication, and therapeutic options, the pace of advancement in managing ASUC has persistently lagged behind the  \nManjeet Kumar Goyal MBBS and Syed Adeel Hassan MBBS denotes co-first authorship due to equal contributions.  \n􀀍 Jeffrey Aaron Berinstein [jberinst@med.umich.edu](jberinst@med.umich.edu)  \n1 Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India  \n2 Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, USA  \nrapid evolution observed in outpatient UC management [3] . ASUC management presents challenges despite these improvements, underscoring the need for further research and innovation. To date, first-line management remains anchored to intravenous (IV) corticosteroids—a 70-yearold intervention with unchanged unacceptably high colectomy rates (25–30%) . Infliximab, which is the only biologic with proven efficacy as a rescue therapy, shows diminishing returns in biologic-refractory and extensively inflamed patients [4, 5] . While several prognostic scores are available, their clinical utility has been limited by poor sensitivity, specificity, and generalizability. This has resulted in a lack of formalized, dynamic, real-time decision thresholds on which to escalate care, leading toa reactive rather than proactive approach [6] . Recently, Janus kinase inhibitors (JAKi) have shown promise in reducing colectomy rates further [7, 8]. However, the optimal timing, sequencing, dosing, and positioning of ","cbCaijr0sQaq79Qk","https://ap.wps.com/l/cbCaijr0sQaq79Qk","pdf",1390300,18,"English","# Abstract\n# Introduction\n# Epidemiology and Disease Burden\n# Summary","[{\"question\":\"What is the main clinical goal in managing acute severe ulcerative colitis (ASUC)?\",\"answer\":\"Reduce high-risk outcomes by optimizing medical strategies to lower colectomy rates and improve patient outcomes, supported by rapid risk stratification.\"},{\"question\":\"Which therapies are discussed as rescue options in ASUC?\",\"answer\":\"The review focuses on infliximab rescue and rescue strategies involving cyclosporine and upadacitinib, alongside emerging approaches such as Janus kinase inhibitors.\"},{\"question\":\"Why is further research needed in ASUC management beyond 2025?\",\"answer\":\"Because best timing, sequencing, dosing, and positioning of newer agents relative to infliximab and cyclosporine are not yet established, and real-time dynamic decision thresholds remain limited.\"}]","Managing Acute Severe Ulcerative Colitis in 2025 and Beyond | PDF",1790751296,45]