Ulcerative Colitis Flashcards
(49 cards)
Recommend stool testing to rule out C diff in patients suspected of having UC
strong, very low evidence
Recommend against serologic antibody testing establish or rule out a diagnosis of UC
strong, very low evidence
Recommend against serologic antibody testing to determine the prognosis of UC
strong, very low evidence
Suggest treating patients w/ UC to achieve mucosal healing (defined as resolution of inflammatory changes (Mayo endoscopic sub score 0 or 1)) to increase the likelihood of sustained steroid-free remission and prevent hospitalizations and surgery
conditional, low evidence
Suggest FC as a surrogate for endoscopy when endoscopy is not feasible or available to assess for mucosal healing
conditional, very low evidence
In patients with mildly active ulcerative proctitis, we recommend rectal 5-ASA therapies at a dose of 1 g/d for induction of remission
strong, high evidence
In patients w/ mildly active left-sided colitis, we recommend rectal 5-ASA enemas at a dose of at least 1 g/d preferred over rectal steroids for induction of remission
strong, moderate evidence
In patients w/ mildly active left-sided UC, we suggest rectal 5-ASA enemas at a dose of at least 1 g/d combined w/ oral 5-ASA at a dose of at least 2 g/d compared w/ oral 5-ASA therapy alone for induction of remission
conditional, low evidence
In patients w/ mildly active left-sided UC who are intolerant or non responsive to oral and rectal 5-ASA at appropriate doses (oral at least 2 g/d and rectal at least 1 g/d), we recommend oral budesonide MMX 9 mg/d for induction of remission
strong, moderate evidence
In patients w/ mildly active extensive colitis, oral 5-ASA at a dose of at least 2 g/d is recommended to induce remission
strong, moderate evidence
In patients w/ UC of any extent who fail to respond to 5-ASA therapy, we recommend oral systemic corticosteroids to induce remission
strong, low evidence
In patients w/ mildly active UC who fail to reach remission with appropriately dosed 5-ASA (at least 2 g/d oral 5-ASA and/or at least 1 g/d rectal 5-ASA), we suggest against changing to an alternative 5-ASA formulation to induce remission. Alternative therapeutic classes should be considered.
conditional, low evidence
In patients w/ mildly active UC of any extent, we suggest using a low dose (2-2.4 g/d) of 5-ASA compared with a higher dose (4.8 g/d), as there is no difference in the remission rate
conditional, very low evidence
In patients w/ mildly to moderately active UC not responding to oral 5-ASA, we recommend the addition of budesonide MMX 9 mg/d to induce remission
strong, moderate evidence
In patients w/ mildly to moderately active UC of any extent using 5-ASA to induce remission, we recommend either once-daily or more frequently dosed oral 5-ASA based on patient preference to optimize adherence, as efficacy and safety are no different
strong, moderate evidence
In patients w/ mildly active ulcerative proctitis, we recommend rectal 5-ASA at a dose of 1 g/d to maintain remission
strong, moderate evidence
In patients w/ mildly active left-sided or extensive UC, we recommend oral 5-ASA therapy (at least 2 g/d) for maintenance of remission
strong, moderate evidence
Recommend against systemic corticosteroids for maintenance of remission in patients w/ UC
strong, moderate evidence
In patients w/ moderately active UC, we recommend oral budesonide MMX for induction of remission
strong, moderate evidence
In patients w/ moderately to severely active UC of any extent, we recommend oral systemic corticosteroids to induce remission
strong, moderate evidence
In patients w/ moderately to severely active UC, we recommend against mono therapy w/ thiopurines or methotrexate for induction of remission
strong, low evidence
In patients w/ moderately to severely active UC, we recommend anti-TNF therapy using adalimumab, golimumab, or infliximab for induction of remission
strong, high evidence
In patients w/ moderately to severely active UC who have failed 5-ASA therapy and in whom anti-TNF therapy is used for induction of remission, we suggest against using 5-ASA for added clinical efficacy
conditional, low evidence
When infliximab is used as induction therapy for patients w/ moderately to severely active UC, we recommend combination therapy w/ a thiopurine
strong, moderate evidence
