Second Brazilian Consensus on the Management of Ulcerative Colitis in Adults: A Consensus of the Brazilian Organization for Crohn’s Disease and Colitis (Gediib)

Abstract

Background -Inflammatory bowel diseases are immune-mediated disorders that include Crohn's disease (CD) and ulcerative colitis (UC). UC is a progressive disease that affects the colorectal mucosa causing debilitating symptoms leading to high morbidity and work disability. As a consequence of chronic colonic inflammation, UC is also associated with an increased risk of colorectal cancer. Objective -This consensus aims to provide guidance on the most effective medical management of adult patients with UC. Methods -A consensus statement was developed by stakeholders representing Brazilian gastroenterologists and colorectal surgeons (Brazilian Organization for Crohn's Disease and Colitis [GEDIIB]). A systematic review including the most recent evidence was conducted to support the recommendations and statements. All recommendations/statements were endorsed using a modified Delphi Panel by the stakeholders/experts in inflammatory bowel disease with at least 80% or greater consensus. Results and conclusion -The medical recommendations (pharmacological and non-pharmacological) were mapped according to the stage of treatment and severity of the disease onto three domains: management and treatment (drug and surgical interventions), criteria for evaluating the effectiveness of medical treatment, and follow-up/ patient monitoring after initial treatment. The consensus targeted general practitioners, gastroenterologists and surgeons who manage patients with UC, and supports decision-making processes by health insurance companies, regulatory agencies, health institutional leaders, and administrators.

Pharmacological Therapy in Inflammatory Bowel Diseases: A Narrative Review of the Past 90 Years

“…The use of salicylates is currently only recommended for the treatment of UC [ 26 , 27 , 28 , 29 ]. The meta-analysis performed by Nikfar and colleagues comparing SSZ with 5-ASA showed no differences in efficacy in the treatment of UC [ 60 ].…”

“…Most recommendations suggest the use of oral 5-ASA at a dose greater than or equal to 2 g daily, and high doses of mesalamine (greater than or equal to 4g daily) may be used in diseases with greater inflammatory activity and during therapeutic induction. The recommended topical dose (suppository or enema) is usually 1 g daily [ 26 , 28 ].…”

“…[ 67 ]. This class is effective for therapeutic induction and quick disease control in situations of clinical flares; however, long-term use is not recommended because it is the class with the highest potential for adverse events [ 28 , 29 ].…”

“…The first generation of GC is the most used, and the main representatives are prednisone, methylprednisolone, and hydrocortisone [ 28 , 29 ]. There is a consensus among international recommendations that doses equivalent to 1 mg/kg of prednisone, not exceeding 40–60 mg daily, are effective for the treatment of IBD [ 28 , 29 ].…”

“…Examples of this generation are ileally acting budesonide, budesonide multi-matrix system, and beclomethasone dipropionate. Although the effectiveness of this class does not parallel that of systemic therapy, some phenotypes of CD (e.g., mild to moderately active ileal Crohn’s disease) and UC (e.g., mild to moderate ulcerative colitis unresponsive to 5-ASA) show benefit in the use of this therapy [ 26 , 28 , 70 ]. The classic study by Campieri et al compared the action of ileal budesonide with prednisone in ileal CD or ileum and right colon CD, demonstrating similarity in achieving clinical remission with lower rates of adverse events in the budesonide group [ 71 ].…”