Management of ulcerative colitis in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease

Abstract

Ulcerative colitis (UC) is an inflammatory bowel disease characterized by chronic mucosal inflammation of the colon, and the prevalence and incidence of UC have been steadily increasing in Taiwan. A steering committee was established by the Taiwan Society of Inflammatory Bowel Disease to formulate statements on the diagnosis and management of UC taking into account currently available evidence and the expert opinion of the committee. Accurate diagnosis of UC requires thorough clinical, endoscopic, and histological assessment and careful exclusion of differential diagnoses, particularly infectious colitis. The goals of UC therapy are to induce and maintain remission, reduce the risk of complications, and improve quality of life. As outlined in the recommended treatment algorithm, choice of treatment is dictated by severity, extent, and course of disease. Patients should be evaluated for hepatitis B virus and tuberculosis infection prior to immunosuppressive treatment, especially with steroids and biologic agents, and should be regularly monitored for reactivation of latent infection. These consensus statements are also based on current local evidence with consideration of factors, and could be serve as concise and practical guidelines for supporting clinicians in the management of UC in Taiwan.

Challenges in the diagnosis of ulcerative colitis with concomitant bacterial infections and chronic infectious colitis

“…[ 13 ] Thereafter, UC was suggested to be a chronic remitting-relapsing disease of the large colon for which an infective cause should be excluded. [ 1 ] Increasing evidence shows that a persistent infection with a specific pathogen was related to degradation of the luminal protective structures and led to UC. [ 2 ] In the present retrospective study, we observed 17 UC patients with a concomitant bacterial infection and compared them to a control group of 46 patients with chronic IC.…”

“…Bloody diarrhea is the most common characteristic symptom of UC,[ 1 ] but elderly patients have a less typical presentation. [ 14 ] In a prospective study of cases of acute bloody diarrhea (<7 days) treated in emergency rooms caused by infectious agents, Shigella species was the most common pathogen (15.3%), followed by Campylobacter and Salmonella spp.…”

“…Ulcerative colitis (UC), an inflammatory bowel disease (IBD) involving the large bowel, is characterized by the presence of diarrhea and bloody mucoid stool. [ 1 ] Exclusion of infectious etiology in the diagnosis of UC is important, as the symptoms of infectious colitis, as well as the endoscopic and histological findings, overlap with UC. [ 1 , 2 ] The prevailing theory of the pathogenesis of UC suggests that the intestinal immune system is inappropriately activated due to a confluence of genetic and environmental factors that leads to inflammatory tissue damage.…”

“…[ 1 ] Exclusion of infectious etiology in the diagnosis of UC is important, as the symptoms of infectious colitis, as well as the endoscopic and histological findings, overlap with UC. [ 1 , 2 ] The prevailing theory of the pathogenesis of UC suggests that the intestinal immune system is inappropriately activated due to a confluence of genetic and environmental factors that leads to inflammatory tissue damage. [ 3 ] Imbalances in the gut flora or specific bacterial strains play an role in the inflammatory process of UC.…”

Response to hepatitis B vaccination in patients with inflammatory bowel disease: a prospective observational study in Korea

“…HBV infection has been reported to cause fulminant or fatal hepatitis by opportunistic infection or reactivation of HBV in IBD patients, but is preventable with a vaccine [ 3 - 6 ]. The American College of Gastroenterology (ACG) clinical guidelines recommend HBV vaccination for every IBD patient lacking HBV immunity with non-immunization regardless of immunosuppression status, especially before the start of anti-tumour necrosis factor (anti-TNF) therapy [ 7 ].…”