## **Core Concept**
Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD) characterized by chronic inflammation and ulceration of the colonic mucosa. Acute exacerbations of UC require prompt treatment to induce remission and prevent complications. The management of acute exacerbations involves the use of medications that can rapidly reduce inflammation.

## **Why the Correct Answer is Right**
The correct answer, **C. Corticosteroids**, is the drug of choice for acute exacerbations of ulcerative colitis because corticosteroids are potent anti-inflammatory agents that can effectively induce remission in patients with acute flare-ups. They work by inhibiting the transcription of inflammatory genes, thereby reducing the production of pro-inflammatory cytokines and mediators. Corticosteroids, such as prednisolone or methylprednisolone, are commonly used for their rapid onset of action in reducing inflammation.

## **Why Each Wrong Option is Incorrect**
* **Option A:** Aminosalicylates (e.g., sulfasalazine, mesalamine) are used for the maintenance of remission and treatment of mild to moderate ulcerative colitis but are not the first choice for acute exacerbations due to their slower onset of action compared to corticosteroids.
* **Option B:** Immunomodulators (e.g., azathioprine, mercaptopurine) are used for maintaining long-term remission and steroid-sparing but are not indicated for the acute management of exacerbations due to their delayed onset of action.
* **Option D:** Biologic agents (e.g., infliximab, adalimumab) can be used for moderate to severe ulcerative colitis that is refractory to conventional therapies, including corticosteroids, but are not the initial treatment for acute exacerbations.

## **Clinical Pearl / High-Yield Fact**
A key point to remember is that while corticosteroids are effective for inducing remission in acute exacerbations of ulcerative colitis, their long-term use is limited by significant side effects. Therefore, once remission is achieved, tapering of corticosteroids and introduction of maintenance therapy (e.g., aminosalicylates, immunomodulators) is crucial to prevent steroid dependence and maintain long-term remission.

## **Correct Answer:** C. Corticosteroids