The COVID-19 pandemic has created unprecedented challenges to healthcare around the globe. In addition, due to the sudden appearance of SARS-CoV-2 and the relative lack of experience with similar viruses on such a large scale, there have been many areas of uncertainty about how best to manage not only the resultant disease, COVID-19, but also other medical conditions in the context of the pandemic.
Acute severe ulcerative colitis (ASUC) is one of the most serious complications of UC with an estimated fatality rate of 1%. The management of ASUC is largely driven by evidence-based protocols1 which rely largely on the use of steroids in combination with rescue therapy and / or surgery where steroids fail, with care being conducted in an inpatient setting. The emergence of COVID-19 revealed concerns that the recommended treatment pathways might be circumvented due to theoretical risks of corticosteroids, immunomodulators and surgery during the pandemic. Shortly after the outbreak of SARS-CoV-2, data collection was initiated in order to guide the management of IBD in the context of the pandemic including registries such as IBD-SECURE2. However, such registries have many potential weaknesses, take time to report and were likely to include only a small number of patients with ASUC. There remained, therefore, a clear need for guidance to aid clinical decision making. The decision was made review the current BSG ASUC guideline1 for managing ASUC to establish whether they should be adapted during the COVID-19 pandemic. In view of the lack of evidence and the short time frame, it would have been inappropriate to go through a formal guidelines process and, clearly, a differen