Aim to achieve mucosal healing when treating patients with ulcerative colitis

The American College of Gastroenterology has updated its guidelines on diagnosis and management of ulcerative colitis in adults. These guidelines have been published in the March 2019 issue of the American Journal of Gastroenterology

Some key recommendations include:

·         Do a stool test to exclude clostridium difficile infection in patients suspected of having ulcerative colitis.

·         Serologic antibody testing is not recommended to either establish a diagnosis or determining the prognosis.

·         Treatment should aim to achieve mucosal healing to increase the chances of sustained steroid-free remission and prevent hospitalizations and surgery. Mucosal healing is defined as resolution of inflammatory changes (Mayo endoscopic subscore 0 or 1).

·         Fecal calprotectin can be used as a noninvasive marker of disease activity and to assess response to therapy and relapse.

·         Preferably use rectal 5-aminosalicylate enemas (at least 1 g/d) over rectal steroids for induction of remission in mildly active left-sided UC.

·         Oral budesonide multi-matrix (MMX) 9 mg/d is recommended for induction of remission in patients with mildly active left-sided UC who are intolerant or nonresponsive to oral and rectal 5-ASA.

·         In patients with moderately to severely active UC of any extent, oral systemic corticosteroids are recommended to induce remission.

·         Monotherapy with thiopurines or methotrexate are not recommended for patients with moderately to severely active ulcerative colitis. Instead, anti-TNF therapy (adalimumab, golimumab or infliximab) should be used in these patients for induction of remission.

·         Do not use systemic corticosteroids for maintenance of remission in these patients.

·         In patients with acute severe ulcerative colitis, DVT prophylaxis and testing for C. difficile infection are recommended. Avoid routine use of broad-spectrum antibiotics in these patients.

·         Consider colectomy in patients with moderately to severely active UC who are refractory or intolerant to medical therapy.

(Source: Am J Gastroenterol. 2019 March;114(3):384-413).

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA