Position statement of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) on the diagnosis and management of acute severe ulcerative colitis.

Abstract

Acute severe ulcerative colitis (ASUC) is a potentially life-threatening medical emergency that requires hospitalization, close multidisciplinary monitoring, and prompt, protocolized decision-making. Despite therapeutic advances, ASUC remains associated with high morbidity and mortality, substantial healthcare resource utilization, and a significant risk of colectomy. This position statement from the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) provides updated, evidence-based recommendations for the diagnosis and management of ASUC in clinical practice. Its development involved a comprehensive review of the literature, including clinical trials, observational studies, and the most recent international guidelines. Diagnosis must be rapid and standardized, with particular emphasis on the systematic exclusion of infections, especially Clostridioides difficile and cytomegalovirus. Intravenous corticosteroids remain the first-line treatment, and response should be assessed at 72hours using validated criteria. In steroid-refractory patients, infliximab and cyclosporine are equally effective rescue therapies, and the choice between them should be individualized according to patient characteristics and comorbidities. JAK inhibitors are emerging as a promising option in selected cases, although current evidence is still limited. Supportive measures, including optimization of nutritional status, thromboprophylaxis, and continuous close monitoring, constitute essential components of care. Early surgical assessment is also crucial in patients who fail to respond to medical therapy or who develop complications. The management of ASUC requires a structured, interdisciplinary approach delivered in specialized centers, integrating early diagnosis, optimization of medical therapy, and timely surgical decision-making. This consensus aims to harmonize clinical practice and contribute to improving outcomes in patients with ASUC.