Inflammatory intestinal diseases
Cure8 research brief
Why This Matters
If you or a loved one with acute severe UC starts upadacitinib, clinicians and patients should be aware of rare but serious reports of massive colonic bleeding occurring despite early clinical improvement. This could affect monitoring and decisions about continuing therapy in ASUC.
Who Should Pay Attention
Clinicians treating acute severe UC, gastroenterologists, patients with ASUC or those starting upadacitinib, and clinicians managing biologic/JAK-inhibitor safety.
Study Snapshot
Story typeResearch paper
Evidence typeResearch paper
Source depthJournal abstract
What To Know
The report covers three patients with ASUC previously treated with corticosteroids and infliximab who received high-dose upadacitinib (45 mg daily).
Shortly after starting UPA, clinical signs (stool frequency, visible blood) and C-reactive protein improved, but each patient later developed massive colonic bleeding requiring transfusion and endoscopic hemostasis.
Endoscopy at the time of bleeding showed improved ulceration but active bleeding from fragile regenerating mucosa or exposed vessels; in two patients bleeding recurred at different sites. Bleeding stopped after UPA was stopped and endoscopic treatment was performed.
The authors note that while gastrointestinal perforation has been reported with UPA, massive colonic bleeding has not been established as a common safety signal and these cases suggest a possible treatment-associated event that may not be explained solely by worsening disease activity.
Follow-up and generalizability are limited by the small case series design; these reports suggest caution and increased vigilance rather than proof of causation.
Keep In Mind
This is an abstract-level case series (three patients). Case reports can signal possible adverse events but cannot establish frequency or causation. The article notes prior reports of GI perforation with UPA but not of massive colonic bleeding as a confirmed safety signal; larger studies and pharmacovigilance data are needed.
Source Details
Review the original publication for the complete reporting, methods, and context.
Research paper
Evidence type derived from source or registry metadata.
PublicationInflammatory intestinal diseases
AuthorsSuzuki K, Asonuma K, Nogami A +3 more
Study typeJournal article, case reports
Indexed viaEurope PMC
Source typeResearch paper
PublishedJan 1, 2026, 12:00 AM
Content availableJournal abstract
This Cure8 brief is based on source text from the linked article. Cure8 is informational only and is not a substitute for professional medical advice, diagnosis, or treatment.
Sweet’s syndrome during anti-TNF therapy with successful rescue using a JAK inhibitor in refractory ulcerative colitis: a case report and literature review
People with UC can develop severe neutrophilic skin complications like Sweet’s syndrome that may reflect active bowel inflammation even when recent tests suggested remission.
Sequential Biologic, Small-Molecule, and GLP-1 Analogue Therapy in Postcolectomy Enteritis With High Output Stoma.
People with ulcerative colitis who have had colectomy can rarely develop inflammation of the small intestine and high-output stomas that are hard to control.
Upadacitinib for Acute Severe Ulcerative Colitis: Real-World Tertiary Care Outcomes.
Hospitalized patients with acute severe ulcerative colitis often need rescue therapy to avoid colectomy.