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Review
. 2020 Aug 17;117(33-34):564-574.
doi: 10.3238/arztebl.2020.0564.

Ulcerative Colitis-Diagnostic and Therapeutic Algorithms

Torsten Kucharzik  1 , Sibylle Koletzko, Klaus Kannengiesser, Axel Dignass
Affiliations
Review

Ulcerative Colitis-Diagnostic and Therapeutic Algorithms

Torsten Kucharzik et al. Dtsch Arztebl Int. .

Abstract

Background: Ulcerative colitis is a chronic inflammatory bowel disease with an estimated 150 000 patients in Germany alone.

Methods: This review is based on publications about current diagnostic and therapeutic strategies for ulcerative colitis that were retrieved by a selective search in PubMed, and on current guidelines.

Results: The primary goal of treatment is endoscopically confirmed healing of the mucosa. Mesalamine, in various forms of administration, remains the standard treatment for uncomplicated ulcerative colitis. Its superiority over placebo has been confirmed in meta-analyses of randomized, controlled trials. Glucocorticoids are highly effective in the acute treatment of ulcerative colitis, but they should only be used over the short term, because of their marked side effects. Further drugs are available to treat patients with a more complicated disease course of ulcerative colitis, including azathioprine, biological agents, JAK inhibitors (among them TNF antibodies, biosimilars, ustekinumab, vedolizumab, and tofacitinib), and calcineurin inhibitors. Proctocolectomy should be considered in refractory cases, or in the presence of high-grade epithelial dysplasia. Ulcerative colitis beginning in childhood or adolescence is often characterized by rapid progression and frequent comorbidities that make its treatment a special challenge.

Conclusion: A wide variety of drugs are now available for the treatment of ulcerative colitis, enabling the individualized choice of the best treatment for each patient. Regular surveillance colonoscopies to rule out colon carcinoma should be scheduled at intervals that depend on risk stratification.

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Figures

Figure 1
Figure 1
The outpatient treatment of uncomplicated ulcerative colitis. BW, body weight; p.o., per os; p.r., per rectum
Figure 2
Figure 2
The treatment of steroid-dependent and steroid-refractory ulcerative colitis
Figure 3
Figure 3
Treatment algorithm for fulminant ulcerative colitis BW, body weight; C. diff., Clostridioides difficile; CMV, cytomegalovirus; d, day; i.v., intravenous; PCR, polymerase chain reaction
See this image and copyright information in PMC

References

    1. Kucharzik T, Dignass AU, Atreya R, et al. [August 2019 - AWMF-Registriernummer: 021-009] Z Gastroenterol. 2019;57:1321–1405. - PubMed
    1. Harbord M, Eliakim R, Bettenworth D, et al. Third European Evidence-based Consensus on diagnosis and management of ulcerative colitis Part 2: Current Management. J Crohns Colitis. 2017;11:769–784. - PubMed
    1. Abdulrazeg O, Li B, Epstein J. Guideline: Management of ulcerative colitis: summary of updated NICE guidance. BMJ. 2019;367 l5897. - PubMed
    1. Dignass AU, Gasche C, Bettenworth D, et al. European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases. J Crohns Colitis. 2015;9:211–222. - PubMed
    1. Maaser C, Sturm A, Vavricka SR, et al. ECCO-ESGAR Guideline for diagnostic assessment in IBD part 1: Initial diagnosis, monitoring of known IBD, detection of complications. J Crohns Colitis. 2019;13:144–164. - PubMed