Medical management of left-sided ulcerative colitis and ulcerative proctitis: Critical evaluation of therapeutic trials

Regueiro, Miguel; Loftus, Edward V.; Steinhart, A. Hillary; Cohen, Russell D.

doi:10.1097/01.mib.0000231495.92013.5e

Cited by 108 publications

(80 citation statements)

References 122 publications

(175 reference statements)

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“…Th e combination of oral mesalamine 1.6 g per day and mesalamine enema 4 g twice weekly was more eff ective than the oral mesalamine alone ( 129 ). Topical corticosteroids, whether hydrocortisone or budesonide, have not proven eff ective for maintaining remission in distal colitis ( 77,78,130 ).…”

Section: (Evidence A) When All Of These Measures Fail To Maintain Rementioning

confidence: 99%

“…Mesalamine enemas in doses of 2 -4 g maintained remission when administered daily (78 % eff ective), every other day (72 % eff ective), or even as infrequently as every third day (65 % eff ective) ( 77,78 ). Sulfasalazine in a dose of 2 g per day, olsalazine 1 g per day, Eudragit-S-coated mesalamine 3.2 g per day, balsalazide 3 -6 g per day (126,127) , and granulated extended release mesalamine capsules 1.5 g per day ( 128 ) were all eff ective in maintaining remission in distal disease.…”

Section: (Evidence A) When All Of These Measures Fail To Maintain Rementioning

confidence: 99%

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Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Kornbluth

Sachar

2010

American Journal of Gastroenterology

1,156

977

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Guidelines for clinical practice are aimed to indicate preferred approaches to medical problems as established by scientifi cally valid research. Double-blind placebo controlled studies are preferable, but compassionate-use reports and expert review articles are used in a thorough review of the literature conducted through Medline with the National Library of Medicine. When only data that will not withstand objective scrutiny are available, a recommendation is identifi ed as a consensus of experts. Guidelines are applicable to all physicians who address the subject regardless of specialty training or interests and are aimed to indicate the preferable but not necessarily the only acceptable approach to a specifi c problem. Guidelines are intended to be fl exible and must be distinguished from standards of care, which are infl exible and rarely violated. Given the wide range of specifi cs in any healthcare problem, the physician must always choose the course best suited to the individual patient and the variables in existence at the moment of decision. Guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee and approved by the board of trustees. Each has been intensely reviewed and revised by the Committee, other experts in the fi eld, physicians who will use them, and specialists in the science of decision analysis. The recommendations of each guideline are therefore considered valid at the time of composition based on the data available. New developments in medical research and practice pertinent to each guideline will be reviewed at a time established and indicated at publication to assure continued validity. The recommendations made are based on the level of evidence found. Grade A recommendations imply that there is consistent level 1 evidence (randomized controlled trials), grade B indicates that the evidence would be level 2 or 3, which are cohort studies or case -control studies. Grade C recommendations are based on level 4 studies, meaning case series or poor-quality cohort studies, and grade D recommendations are based on level 5 evidence, meaning expert opinion.

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Section: (Evidence A) When All Of These Measures Fail To Maintain Rementioning

confidence: 99%

Section: (Evidence A) When All Of These Measures Fail To Maintain Rementioning

confidence: 99%

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Kornbluth

Sachar

2010

American Journal of Gastroenterology

1,156

977

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“…Udowodniono, że takie postępowanie jest skuteczniejsze niż terapia wyłącznie preparatem doustnym lub doodbytniczym. Lekiem alternatywnym dla doodbytniczych preparatów mesalazyny w wybranych przypadkach mogą być steroidy doodbytnicze w postaci wlewek lub pianki (hydrokortyzon, budezonid) [7,[38][39][40][41].…”

Section: A -100% B -0% C -0% D -0% E -0%unclassified

Guidelines for the management of ulcerative colitis. Recommendations of the Working Group of the Polish National Consultant in Gastroenterology and the Polish Society of Gastroenterology

Eder¹,

Łodyga²,

Łykowska‐Szuber³

et al. 2013

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“…Foam preparations are usually better tolerated and accepted by patients with acute flares of left sided colitis. 7 Mesalazin suppositories seem to be well tolerated in patients with proctitis and recommended by the ECCO guidelines as first line treatment. 8 Compliance and patient acceptance are essential for the success of a rectal therapy.…”

Section: Introductionmentioning

confidence: 99%

Topical therapy is underused in patients with ulcerative colitis

Seibold

Fournier

Beglinger

et al. 2014

Journal of Crohn's and Colitis

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The availability of new topical preparations for the treatment of left sided ulcerative colitis offers a therapy optimization for many patients. Rectal application of steroids and 5-aminosalicylic acid (5-ASA) is associated with fewer side effects and has a higher therapeutic efficacy in left-sided colitis as compared to a systemic therapy. Therefore, we were interested in the use of topical therapy in patients with ulcerative colitis. The key question was whether topical treatment is more frequently used than oral therapy in patients with proctitis and left sided colitis. Data of 800 patients of the Swiss IBD cohort study were analyzed. Sixteen percent of patients of the cohort had proctitis, 21% proctosigmoiditis and 41% pancolitis. Topical therapy with 5-ASA or corticosteroids was given in 26% of patients with proctitis, a combined systemic and topical treatment was given in 13%, whereas systemic treatment with 5-ASA without topical treatment was given in 29%. Proportion of topical drug use decreased with respect to disease extension from 39% for proctitis to 13.1% for pancolitis (P = 0.001). Patients with severe colitis received a significantly higher dose of topical 5-ASA than patients in remission.

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Medical management of left-sided ulcerative colitis and ulcerative proctitis: Critical evaluation of therapeutic trials

Abstract: This critical evaluation of treatment provides a "report card" on medications available for the management of patients with UP and L-UC. The guidelines should provide a useful reference and supplement for physicians treating UC patients.

Cited by 108 publications

References 122 publications

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Guidelines for the management of ulcerative colitis. Recommendations of the Working Group of the Polish National Consultant in Gastroenterology and the Polish Society of Gastroenterology

Topical therapy is underused in patients with ulcerative colitis

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