Management of ulcerative colitis in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease updated in 2023

Hsu-Heng Yen^{1

2}, Jia-Feng Wu³, Horng-Yuan Wang^{4

5

6}, Ting-An Chang⁷, Chung-Hsin Chang⁸, Chen-Wang Chang^{4

5

6}, Te-Hsin Chao⁹, Jen-Wei Chou^{10

11}, Yenn-Hwei Chou¹², Chiao-Hsiung Chuang¹³, Wen-Hung Hsu^{14

15}, Tzu-Chi Hsu¹⁶, Tien-Yu Huang¹⁷, Tsung-I Hung¹², Puo-Hsien Le^{18

19

20}, Chun-Che Lin^{21

22

23}, Chun-Chi Lin^{24

25}, Ching-Pin Lin^{21

22

23}, Jen-Kou Lin^{24

25}, Wei-Chen Lin⁴, Yen-Hsuan Ni²⁶, Ming-Jium Shieh²⁷, I-Lun Shih²⁸, Chia-Tung Shun^{29

30}, Tzung-Jiun Tsai^{31

32}, Cheng-Yi Wang³³, Meng-Tzu Weng^{33

34}, Jau-Min Wong³³, Deng-Chyang Wu^{35

36

37}, Shu-Chen Wei³³

Affiliations

¹ Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
² Division of Gastroenterology, Changhua Christian Hospital, Changhua, Taiwan.
³ Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
⁴ Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
⁵ MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.
⁶ MacKay Medical College, Taipei, Taiwan.
⁷ Department of Pathology, Taipei City Hospital, Renai-Branch, Taipei, Taiwan.
⁸ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
⁹ Division of Colon and Rectal Surgery, Department of Surgery, Chiayi and Wangiao Branch, Taichung Veterans General Hospital, Taichung, Taiwan.
¹⁰ Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
¹¹ School of Chinese Medicine, China Medical University, Taichung, Taiwan.
¹² Division of General Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
¹³ Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
¹⁴ Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
¹⁵ Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan.
¹⁶ Division of Colon and Rectal Surgery, Department of Surgery, MacKay Memorial Hospital, MacKay Medical College, Taipei, Taiwan.
¹⁷ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
¹⁸ Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
¹⁹ Chang Gung Microbiota Therapy Center, Linkou Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
²⁰ Inflammatory Bowel Disease Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
²¹ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
²² Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
²³ School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
²⁴ Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
²⁵ Department of Surgery, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
²⁶ Department of Pediatrics, National Taiwan University College of Medicine and Children's Hospital, Taipei, Taiwan.
²⁷ Department of Oncology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
²⁸ Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.
²⁹ Department of Forensic Medicine and Pathology, National Taiwan University Hospital, Taipei, Taiwan.
³⁰ Department of Pathology, Good Liver Clinic, Taipei, Taiwan.
³¹ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
³² School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
³³ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
³⁴ Department of Medical Research, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan.
³⁵ Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Gangshan Hospital, Kaohsiung, Taiwan.
³⁶ Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
³⁷ Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.

PMID: 39099217
PMCID: PMC11309818
DOI: 10.5217/ir.2023.00050

Management of ulcerative colitis in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease updated in 2023

Hsu-Heng Yen et al. Intest Res. 2024 Jul.

. 2024 Jul;22(3):213-249.

doi: 10.5217/ir.2023.00050. Epub 2024 Jul 29.

Authors

Affiliations

¹ Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
² Division of Gastroenterology, Changhua Christian Hospital, Changhua, Taiwan.
³ Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
⁴ Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
⁵ MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.
⁶ MacKay Medical College, Taipei, Taiwan.
⁷ Department of Pathology, Taipei City Hospital, Renai-Branch, Taipei, Taiwan.
⁸ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
⁹ Division of Colon and Rectal Surgery, Department of Surgery, Chiayi and Wangiao Branch, Taichung Veterans General Hospital, Taichung, Taiwan.
¹⁰ Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
¹¹ School of Chinese Medicine, China Medical University, Taichung, Taiwan.
¹² Division of General Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
¹³ Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
¹⁴ Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
¹⁵ Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan.
¹⁶ Division of Colon and Rectal Surgery, Department of Surgery, MacKay Memorial Hospital, MacKay Medical College, Taipei, Taiwan.
¹⁷ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
¹⁸ Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
¹⁹ Chang Gung Microbiota Therapy Center, Linkou Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
²⁰ Inflammatory Bowel Disease Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
²¹ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
²² Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
²³ School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
²⁴ Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
²⁵ Department of Surgery, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
²⁶ Department of Pediatrics, National Taiwan University College of Medicine and Children's Hospital, Taipei, Taiwan.
²⁷ Department of Oncology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
²⁸ Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.
²⁹ Department of Forensic Medicine and Pathology, National Taiwan University Hospital, Taipei, Taiwan.
³⁰ Department of Pathology, Good Liver Clinic, Taipei, Taiwan.
³¹ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
³² School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
³³ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
³⁴ Department of Medical Research, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan.
³⁵ Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Gangshan Hospital, Kaohsiung, Taiwan.
³⁶ Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
³⁷ Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.

PMID: 39099217
PMCID: PMC11309818
DOI: 10.5217/ir.2023.00050

Abstract

Ulcerative colitis (UC) is a chronic inflammation of the gastrointestinal tract and is characterized by alternating periods of inflammation and remission. Although UC incidence is lower in Taiwan than in Western countries, its impact remains considerable, demanding updated guidelines for addressing local healthcare challenges and patient needs. The revised guidelines employ international standards and recent research, emphasizing practical implementation within the Taiwanese healthcare system. Since the inception of the guidelines in 2017, the Taiwan Society of Inflammatory Bowel Disease has acknowledged the need for ongoing revisions to incorporate emerging therapeutic options and evolving disease management practices. This updated guideline aims to align UC management with local contexts, ensuring comprehensive and context-specific recommendations, thereby raising the standard of care for UC patients in Taiwan. By adapting and optimizing international protocols for local relevance, these efforts seek to enhance health outcomes for patients with UC.

Keywords: Consensus; Guidelines; Management; Taiwan; Ulcerative colitis.

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Conflict of interest statement

Conflict of Interest

Wong JM and Wei SC are editorial board members of the journal but were not involved in the peer reviewer selection, evaluation, or decision process of this article. No other potential conflicts of interest relevant to this article were reported.

Figures

**Fig. 1.**
Recommended algorithm for the treatment of UC. ^a1 g/day. ^b≥2 g/day. ^c≥1 g/day. ^d9 mg/day. ^e1.0–2.5 mg/kg/day. ^f0.45–1.5 mg/kg/day. ^gAnti-tumor necrosis factor (infliximab, adalimumab; golimumab), vedolizumab, ustekinumab, JAK inhihitors (tofacitinib, upadacitinib) or ozanimod. 5-ASA, 5-aminosalicylic acid; Tx, treatment; MMX, multi-matrix; UC, ulcerative colitis; AZA, azathioprine; 6-MP, 6-mercaptopurine; IV, intravenous.

**Fig. 2.**
Recommended algorithm for the treatment of acute severe ulcerative colitis (UC). ^aComplete blood count, C-reactive protein, electrolytes, liver enzymes, hepatitis B virus, hepatitis C virus, etc; ^bStool culture, Clostridium difficile toxin, viruses; ^cMethylprodcisionle 1 mg/ kg/day or 60 mg/day, maximally, or hydrocortisone 100 mg×4 times daily, maximally; ^dTreatment failure, C-reactive protein >4.5 mg/dL & blood stool 3–8 times/day or bloody stool >8 times/day. TB, tuberculosis; CT, computed tomography; IV, intravenous; 5-ASA, 5-aminosalicylic acid.

See this image and copyright information in PMC

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Management of ulcerative colitis in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease updated in 2023

Affiliations

Management of ulcerative colitis in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease updated in 2023

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources