Ulcerative colitis (UC) is a chronic, relapsing and remitting autoimmune condition affecting the colon. Patients with UC have a 20% lifetime risk of presenting with acute severe ulcerative colitis (ASUC), a severe complication that may result in the need for emergency colectomy and stoma formation. Patients who present with ASUC require intravenous corticosteroids as initial therapy. For those who fail to respond sufficiently to corticosteroids, infliximab, a potent tumor necrosis factor alpha inhibitor, is given to reduce the risk of colectomy. However, there remains a 20-30% residual risk of colectomy despite corticosteroid use and infliximab salvage. This reflects a knowledge gap in ASUC management, owing to a lack of novel predictive biomarkers, the unknown optimal drug dosing regimens and unclear efficacy and safety of more novel third line therapies in the event of infliximab failure, such as JAK inhibitors.

The goal of this research topic is to further the understanding of ASUC pathogenesis, discover novel biomarkers that can be utilized in the management algorithm of ASUC, evaluate the efficacy of different dosing regimens and strategies of salvage Infliximab and explore the safety and efficacy of further medical options in the event of Infliximab failure or prior Infliximab exposure.

We welcome all study/article types including original research, case reports/case series and review articles that focus on one or more of the following themes:

1. Understanding the pathogenesis of ASUC and non-response to salvage therapies such as corticosteroids and infliximab, including the role of the immune system and the gut microbiome.

2. Novel biomarkers to predict response or failure of ASUC management options.

3. Optimal dosing regimens and novel use-cases of salvage infliximab.

4. Safety and efficacy of other medical options such as Tofacitinib, Upadacitinib and others.

5. Novel diagnostic or predictive tools to guide ASUC management including machine learning.

6. Optimal long-term maintenance strategy after successful in-hospital management of ASUC.

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Frontiers in Gastroenterology

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