Ulcerative Colitis Guidelines

When treating their patients, physicians want to use the best tests and the most effective treatments available. This often means making choices from many possible alternatives, including new medical products that are constantly being developed.

To help doctors make the best choices, large medical organizations publish treatment guidelines. These guidelines recommend the most appropriate tests and treatments to use for a particular condition, based on clinical research and the advice of leading experts on that disease.

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While doctors often follow guidelines closely, they can also make different choices, based on their own judgement and medical experience, as well as the patient's own preferences. A good doctor will know what the guidelines say, and will have sound reasons for making choices that they do not include. For example, a doctor may prescribe a new medication that was not available when the guidelines were last updated. Updating guidelines is a big job, and there may be several years between updates.

For ulcerative colitis, those guidelines are published by the Canadian Association of Gastroenterology (CAG). The most recent version was published in 2015 and can be found here (PDF). The guidelines consist of statements about the treatment of patients with mild to severe active ulcerative colitis that are not in the hospital. Although the guidelines are published by CAG, international physicians were involved in the creation of the guidelines. The guidelines apply to all countries.

As pointed out in the guidelines, the statements focus on “5 main drug classes: 5-aminosalicylate (5-ASA), corticosteroids, immunosuppressants, anti–tumor necrosis factor (TNF) therapies, and other therapies.” Summarized, the statements divide patients and appropriate treatments into 3 groups.

  1. Patients with mild to moderate ulcerative colitis are recommended to start with oral and rectal 5-ASA. If 5-ASA doesn’t help those patients achieve remission, corticosteroid therapy is recommended.
  2. Patients with moderate to severe ulcerative colitis are recommended to start with oral corticosteroid therapy. Once they reach remission they should be transitioned to 5-ASA, thiopurine, anti-TNF, or vedolizumab.
  3. Patients whose ulcerative colitis is corticosteroid-resistant/dependent should be treated with anti-TNF or vedolizumab therapy.

In all 3 cases the patient’s response to the treatments should be monitored to make sure that the patient’s ulcerative colitis is treated optimally. More details about treating ulcerative colitis can be found here: treatments for ulcerative colitis.

Note: While doctors often follow guidelines closely, they can also make different choices based on their own judgment and medical experience, as well as the patient’s own references. A good doctor will know what the guidelines say, and will have sound reasons for making choices that they don’t include. For example, a doctor may prescribe a new medication that was not available when the guidelines were last updated. Updating guidelines is a big job, and there may be several years between updates.

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