Clinical guidelines for the medical management of left-sided ulcerative colitis and ulcerative proctitis: summary statement.

Abstract

There are few published guidelines for the treatment of inflammatory bowel disease. Physicians choose therapy based on evidence-based data, peer and expert opinion, and personal experience. This article provides treatment guidelines for the induction and maintenance of ulcerative proctitis and left-sided colitis and the management of disease refractory to 5-aminosalicylic acid (5-ASA) compounds and corticosteroids The guidelines are derived from evidence-based data and, when lacking, expert opinion or the authors' experience. The comprehensive review of the literature is presented in the accompanying article, "The Medical Management of Left-Sided Ulcerative Colitis and Ulcerative Proctitis: Critical Evaluation of Therapeutic Trials". Rectally administered 5-ASA and corticosteroid suppositories are effective treatment for most ulcerative proctitis patients. Corticosteroid and 5-ASA enemas, which reach the splenic flexure of the colon, are recommended for patients with left-sided ulcerative colitis. The combination of rectally administered 5-ASA enemas and oral 5-ASA agents may afford better treatment of left-sided colitis and possibly prevent proximal extension of disease. Patients refractory to 5-ASAs and corticosteroids may require an immunomodulator or biological response modifier therapy. Those who have ongoing signs and symptoms of ulcerative proctitis and left-sided ulcerative colitis despite maximal medical therapy require a proctocolectomy.

• Authors: Miguel Regueiro, Edward V Loftus Jr, A Hillary Steinhart, Russell D Cohen, Inflammatory Bowel Disease Center
• Journal: Inflammatory bowel diseases (Inflamm Bowel Dis) Vol. 12 Issue 10 Pg. 972-8 (Oct 2006) ISSN: 1078-0998 [Print] England
• PMID: 17012968 (Publication Type: Journal Article)

Chemical References

• Adrenal Cortex Hormones
• Anti-Inflammatory Agents, Non-Steroidal
• Mesalamine

Topics

• Adrenal Cortex Hormones (therapeutic use)
• Algorithms
• Anti-Inflammatory Agents, Non-Steroidal (therapeutic use)
• Colitis, Ulcerative (drug therapy, therapy)
• Drug Resistance (drug effects)
• Humans
• Mesalamine (therapeutic use)
• Models, Biological
• Proctitis (drug therapy, therapy)
• Remission Induction (methods)