2017 European Ulcerative Colitis Guidelines – Therapy – Part Two of Two Parts

Part I of the guidelines [link in Resource (2)] concerns diagnosis.

The article discussed in this post, Part 2 discusses the therapy of ulcerative colitis.  It is critically important for every physician to be able to recognize severe ulcerative colitis as severe ulcerative colitis requires hospitalization. What follows is from Part 2 of the guidelines

11.1. General

The treatment strategy for ulcerative colitis [UC] is mainly based on the severity, distribution [proctitis, left-sided, extensive]1 and pattern of disease. The latter includes relapse frequency, disease course, response to previous medications, side effects of medication, and extra-intestinal manifestations. Age at onset, and disease duration are also important factors. It is important to distinguish patients with severe UC necessitating hospital admission from those with mild or moderately active disease who can be managed as outpatients. The best validated and most widely used index for identifying severe UC remains that of Truelove and Witts.2 Patients with bloody stool frequency ≥ 6/day and a tachycardia [> 90 min−1], or temperature > 37.8°C, oranaemia [haemoglobin < 10.5 g/dl], or an elevated erythrocyte sedimentation rate [ESR] [> 30 mm/h] have severe UC. Only one additional criterion in addition to the bloody stool frequency ≥ 6/day is needed to define a severe attack.3,4 In practice, a C-reactive protein [CRP] of 30 mg/l can be substituted for the ESR.

The 2017 Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis, Part 2 [Resource (1) below] is a good article. But it is probably most useful to gastroenterologists, surgeons, and emergency physicians rather than to primary care physicians.

Article Contents

Resources:

(1) Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 2: Current Management [PubMed Citation] [Full Text HTML] [Full Text PDF]. J Crohns Colitis. 2017 Jul 1;11(7):769-784. doi: 10.1093/ecco-jcc/jjx009.

(2) Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-intestinal Manifestations, Pregnancy, Cancer Surveillance, Surgery, and Ileo-anal Pouch Disorders [PubMed Citation] [Full Text HTML] [Full Text PDF]. J Crohns Colitis. 2017 Jun 1;11(6):649-670. doi: 10.1093/ecco-jcc/jjx008.

 

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