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

Miguel Regueiro, Edward V. Loftus, A. Hillary Steinhart, Russell D. Cohen

Research output: Contribution to journalReview article

49 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)972-978
Number of pages7
JournalInflammatory bowel diseases
Volume12
Issue number10
DOIs
StatePublished - Oct 1 2006

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Keywords

  • 5-aminosalicylates
  • Corticosteriods
  • Immunomodulators
  • Infliximab
  • Left-sided ulcerative colitis
  • Medical management
  • Medical treatment
  • Ulcerative colitis
  • Ulcerative proctitis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology

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