Objective: Provide direction regarding choice of therapy for patients with ulcerative colitis |
Patient population: Adult patients (>18 years) with known diagnosis of ulcerative colitis |
Highlight BoxNew therapies are constantly being developed and should be considered. |
Ulcerative colitis (UC) is a chronic inflammatory condition of the large intestine limited to the mucosal layer of the colon extending proximally from the rectum, to varying extent. UC is diagnosed based on a combination of clinical presentation, endoscopic findings, and histological features indicating chronic inflammation. It is important to define the extent and severity of inflammation to guide the selection of appropriate treatment and predict prognosis.
Montreal classification of ulcerative colitis based on disease extent is classified as follows:
Definitions, suggested diagnostic work-up and goal of therapy:
The following algorithms are best practice clinical pathways for therapy decisions for patients with ulcerative colitis:
Inflammatory Bowel Disease: Drug Comparison chart
UpToDate® — Patient education: Ulcerative colitis (Beyond the Basics) (freely accessible) https://www.uptodate.com/contents/ulcerative-colitis-beyond-the-basics?topicRef=2004&source=see_link
Danese S. et al. Positioning Therapies in Ulcerative Colitis. Clin Gastroenterol and Hepatol 2020; In press
Rubin DT et al. ACG Clinical Guideline: Ulcerative Colitis in Adults. Am J Gastroenterology 2019; 114:384
Bressler and Marshall et al. Clinical Practice Guidelines for the Medical Management of Nonhospitalized Ulcerative Colitis: The Toronto Consensus. Gastroenterology 2015; 148:1035-1058
Bitton A. et al. Treatment of Hospitalized Adult Patients with Severe Ulcerative Colitis: Toronto Consensus Statements. Am J Gastroenterology 2011; 179-194
Turner D, Ricciuto A, Lewis A, et al. STRIDE-II: An Update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) Initiative of the International Organization for the Study of IBD (IOIBD): Determining Therapeutic Goals for Treat-to-Target strategies in IBD. Gastroenterology. 2021;160(5):1570-1583.