Medical management of left-sided ulcerative colitis and ulcerative proctitis: Critical evaluation of therapeutic trials

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

Research output: Contribution to journalReview articlepeer-review

92 Scopus citations

Abstract

BACKGROUND: The goal of this work was to critically evaluate the published studies on the treatment of ulcerative proctitis (UP) and left-sided ulcerative colitis (L-UC). The results of this review provided the content for the accompanying treatment guidelines, Clinical Guidelines for the Medical Management of Left-sided Ulcerative Colitis and Ulcerative Proctitis: Summary Statement. METHODS: All English language articles published between 1995 and September 2005 were identified through a comprehensive literature search using OVID and PubMed. The quality of the data supporting or rejecting the use of specific therapies was categorized by a data quality grading scale. An "A+" grade was assigned to treatment supported by multiple high-quality randomized controlled trials with consistent results, whereas a "D" grade was given to therapy supported only by expert opinion. The therapeutic efficacy of a treatment was defined by its success in treating UP and L-UC compared with placebo. A medication was ranked as "excellent" if it was specifically studied for UP and L-UC and had consistently positive results compared with placebo or another agent. Quality and efficacy scores were agreed on by author consensus. RESULTS: For the acute treatment of UP or L-UC, the rectally administered corticosteroids and mesalazine (5-ASA), either alone or in combination with oral 5-ASAs, are the most effective therapy: evidence quality, A+; efficacy, excellent. Only rectally administered 5-ASA received an A+/excellent rating for maintenance of remission. Infliximab received an A+ grade for induction and maintenance of remission but only a "good" rating because the studies were performed in all UC, not specifically UP or L-UC. CONCLUSIONS: This critical evaluation of treatment provides a "report card" on medications available for the management of patients with UP and L-UC. The guidelines should provide a useful reference and supplement for physicians treating UC patients.

Original languageEnglish (US)
Pages (from-to)979-994
Number of pages16
JournalInflammatory bowel diseases
Volume12
Issue number10
DOIs
StatePublished - Oct 1 2006

Keywords

  • 5-aminosalicylic acid
  • Biologic response modifiers
  • Colitis
  • Corticosteroids
  • Distal ulcerative colitis
  • Immunomodulators
  • Infliximab
  • Left sided ulcerative
  • Medical management
  • Medical therapy
  • Medical treatment
  • Ulcerative colitis
  • Ulcerative proctitis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology

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