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.

Keywords: Consensus statements; Disease management; Inflammatory bowel disease; Taiwan; Ulcerative colitis.

Fig. 1. Recommended checklist for use during histological assessment of UC. Use of this checklist during histological assessment to support thorough evaluation of mucosal architecture and inflammatory infiltrates and exclusion of differential diagnoses is recommended. TB, tuberculosis; CMV, cytomegalovirus.

Fig. 2. Recommended algorithm for the treatment of UC. Treatment algorithm for patients with mild-to-moderate or severe UC developed through consensus of an expert panel established by the Taiwan Society of Inflammatory Bowel Disease. Recommendations were formulated after consideration of available evidence and expert opinion as well as the medical environment specific to Taiwan. ^aOral budesonide-MMX (9 mg/day) could be an alternative; ^bFor patients with acute severe UC, infliximab is better. 5-ASA, 5-aminosalicylic acid (mesalamine); Tx, treatment; AZA, azathioprine; 6-MP, 6-mercaptopurine; IV, intravenous; CMV, cytomegalovirus; MMX, Multi-Matrix System; TFDA, Taiwan Food and Drug Administration.