intensive vs standard infliximab dosing. (No recommendation, knowledge gap) 1458 Feuerstein et al Gastroenterology Vol. 158, No. 5 CLINICAL PRACTICE GUIDELINES The guideline panel makes no recommendation regarding routine use of intensive vs standard infliximab dosing in adult patients hospitalized with ASUC refractory to intravenous corticosteroids. There were no RCTs comparing different dosing regimens in patients hospitalized with ASUC. Five observational studies compared outcomes in patients hospitalized with ASUC refractory to intravenous corticosteroids, being treated with different infliximab regimens.44–47 Intensive dosing regimens included either shortened interval between the infliximab dosing (Ulcerative colitis (UC) is an idiopathic inflammatory disorder. These guidelines indicate the preferred approach to the management of adults with UC and represent the official practice recommendations of the American College of Gastroenterology. The scientific evidence for these guidelines was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process. In instances where the evidence was not appropriate for GRADE, but there was consensus of significant clinical merit, “key concept” statements were developed using expert consensus. These guidelines are meant to be broadly applicable and should be viewed as the preferred, but not only, approach to clinical scenarios. INTRODUCTION Ulcerative colitis (UC) is a chronic disease affecting the large intestine, with an increasing incidence worldwide. Nearly 1 million individuals each in the United States and Europe are affected by this condition and many more globally. Over the past decade, since the publication of the last guideline from the American College of Gastroenterology (ACG) on this topic, the management of disease has grown increasingly complex with availability of additional therapeutic classes. In addition, algorithms for initiating, optimizing, and monitoring response to existing therapies have undergone considerable evolution. UC is a chronic immune-mediated inflammatory condition of the large intestine that is frequently associated with inflammation of the rectum but often extends proximally to involve additional areas of the colon. The absence of rectal involvement has been noted in fewer than 5% of adult patients with UC at diagnosis but may be seen in up to one-third of pediatric-onset colitis (1). The initial presentation of new UC is characterized by symptoms of an inflamed rectum, namely, bleeding, urgency, and tenesmus (a sense of pressure). The condition may present at any time and at all ages, but there is a predominant age distribution of onset that peaks between ages 15 and 30 years. The pattern of disease activity is most often described as relapsing and remitting, with symptoms of active disease alternating with periods of clinical quiescence, which is called remission. Some patients with UC have persistent disease activity despite diagnosis and medical therapy, and a small number of patients present with the rapid-onset progressive type of colitis known as fulminant disease (2,3). UC causes significant morbidity and a described low incidence of mortality (4,5). Patients with active disease are more likely to have comorbid psychological conditions of anxiety and depression and are more likely to have impaired social interactions or career progression (6). Long-standing UC is also associated with a defined risk of dysplasia and colorectal cancer, which is believed to be related to long-standing unchecked inflammation (7–10). Management of UC