A survey on the practices and patterns in the management of acute severe ulcerative colitis in India

The real-world management of acute severe ulcerative colitis (ASUC) varies considerably across regions and healthcare settings. This study aimed to evaluate current management practices for ASUC among gastroenterologists in India.

A structured, web-based survey covering 5 thematic domains (provider and institutional characteristics, clinical workload and initial management, diagnostic practices, infectious work-up, and strategies for rescue therapy) was disseminated via email. Responses were analyzed using descriptive statistics.

A total of 228 responses were received from across India's 5 geographic zones. The majority of respondents were affiliated with either corporate hospitals (n = 76, 33.3%) or teaching hospitals (n = 68, 29.8%). The majority (n = 135, 59.2%) reported managing up to 10 ASUC cases annually. The Truelove and Witts criteria were the most commonly used for diagnosis (n = 169, 74.1%). Nutritional assessment was performed by 89 respondents (39.0%). Biopsies for cytomegalovirus during index sigmoidoscopy were obtained by 75 (32.9%). Intravenous hydrocortisone was the preferred steroid (n = 188, 82.5%). Low molecular weight heparin for thromboprophylaxis was never prescribed by 62 respondents (27.2%). Oxford criteria were most frequently used to assess steroid response (n = 150, 65.8%). More than half of the respondents (n = 125, 54.8%) reported that fewer than 50% of patients accepted rescue therapy. Rescue therapy was initiated on or after day 5 by 153 respondents (67.1%). Early involvement of colorectal surgeons was reported by 66 (28.9%). A majority (n = 200, 87.7%) were associated with low-volume centers for ileal pouch-anal anastomosis, performing < 5 procedures per year.

This nationwide survey reveals considerable heterogeneity in ASUC management in India. Standardizing care through patient and healthcare provider education and context-specific guidelines is imperative.