Updated S3-Guideline Ulcerative Colitis. German Society for Digestive and Metabolic Diseases (DGVS)

Abstract

This guideline provides evidence-based key recommendations for diagnosis and treatment of ulcerative colitis and upgrades the 2011 version. The guideline was developed by an interdisciplinary team of gastroenterologists, surgeons, pathologists, nutrition experts, and patient support groups under the auspice of the German Society for Gastroenterology and Metabolic Diseases. The guideline used structural S3 consensus-based methodology and includes statements on clinical practice, prevention, infectiological problems, surgery and nutrition.

Recent Advances and the Potential for Clinical Use of Autofluorescence Detection of Extra-Ophthalmic Tissues

“…A range of studies already explored the addition of AFI to endoscopic approaches for gastrointestinal diseases. However, the application of AFI, alone or as part of the ETMI procedure, is not mentioned in clinical guidelines for the diagnosis of GI tract malignancies [168][169][170]. Here, our review reflects AFI's heterogeneous results in detecting gastrointestinal inflammation or neoplastic malignancies.…”

Mit Morbus Crohn und Colitis ulcerosa sicher durch die Schwangerschaft

“…Darüber hinaus ist das Risiko für Schwangerschafts-und Geburtskomplikationen am höchsten, wenn während der Schwangerschaft eine aktive CED-Inflammation vorliegt [15]. Somit empfiehlt es sich bereits vor der Konzeption im Rahmen der Kinderwunschbesprechung den aktuellen CED-Status zu erheben und eine endoskopische Evaluation und Karzinomsurveillance entsprechend der geltenden Empfehlungen [16] durchzuführen. Laborkontrollen des Blutbildes, des Vitamin B12-, Vitamin D-, Folsäure-und Eisenstatus sind notwendig, da eine Anämie oder entsprechende Mikronährstoffmangelzustände in der Schwangerschaft häufig aggravieren können.…”

Cost-effectiveness of tofacitinib compared with infliximab, adalimumab, golimumab, vedolizumab and ustekinumab for the treatment of moderate to severe ulcerative colitis in Germany

“…Ulcerative colitis (UC) is a chronic, immune-mediated inflammatory bowel disease (IBD) that affects the colon and rectum and is characterized by episodic disease flares, alternating with phases of remission. [1,2,3] The major symptoms of UC include bloody diarrhea, rectal bleeding, passage of mucus, tenesmus (a continual or recurrent need to evacuate the bowels), urgency (feeling of immediate necessity to evacuate the bowels), and abdominal pain. [4,5] Systemic symptoms include fatigue, fever, weight loss, and dehydration.…”

“…[4,5] Systemic symptoms include fatigue, fever, weight loss, and dehydration. [4,5] In Germany, about 150,000 people suffer from UC, [3] and prior research has suggested it is associated with a substantial economic burden for society. The average annual cost per UC patient to the German statutory health insurance (SHI) is € 2,477.72; 74 % of this amount results from drug usage, 10 % from inpatient care, and another 10 % from ambulatory procedures.…”

“…Almost half of patients with UC experience disease progression that necessitates the use of immunosuppressive therapies with steroids, thiopurines, and biologics (such as tumor necrosis factor inhibitors [TNFi], human interleukin-12/23 antagonist ustekinumab, or antiintegrin vedolizumab). [3,7] The effectiveness of biologics, predominantly anti-TNF agents, may wane over time as some patients may develop a neutralizing anti-drug antibody, necessitating an increase in dosage and/or frequency of administration, at the risk of more adverse events (AE). [8,9,10,11,12,13,14,15] Tofacitinib is an oral Janus kinase (JAK) inhibitor used to treat adult patients with moderate to severe UC who have had an inadequate response, lost response, or were intolerant to either conventional therapy or a biologic agent.…”