American Gastroenterological Association Technical Review on the Management of Mild to Moderate Ulcerative Colitis.
Gastroenterology. 2018 Dec 18;:
Authors: Singh S, Feuerstein JD, Binion DG, Tremaine WJ
Most patients with ulcerative colitis (UC) have mild to moderate disease activity, with low risk of colectomy, and are managed by primary care physicians or gastroenterologists. Optimal management of these patients decreases the risk of relapse and proximal disease extension, and may prevent disease progression, complications and need for immunosuppressive therapy. With several medications (sulfasalazine, diazo-bonded 5-aminosalicylates [ASA], mesalamines, corticosteroids including budesonide, etc.) and complex dosing formulations, regimens and routes, to treat a disease with variable anatomic extent, there is considerable practice variability in the management of patients with mild-moderate UC. Hence, the AGA prioritized clinical guidelines on this topic. To inform clinical guidelines, this technical review was developed in accordance with the GRADE framework for interventional studies. Focused questions included: (1) comparative effectiveness and tolerability of different oral 5-ASA therapies (sulfalsalazine vs. diazo-bonded 5-ASAs vs. mesalamine; low- (<2g) vs. standard (2-3g/d) vs. high-dose (>3g/d) mesalamine); (2) comparison of different dosing regimens (once-daily vs. multiple times per day dosing) and routes (oral vs. rectal vs. both oral and rectal); (3) role of oral budesonide in patients mild-moderate UC; (4) comparative effectiveness and tolerability of rectal 5-ASA and corticosteroid formulations in patients with distal colitis; and (5) role of alternative therapies like probiotics, curcumin and fecal microbiota transplantation in the management of mild-moderate UC.
PMID: 30576642 [PubMed – as supplied by publisher]