Journal List > Korean J Gastroenterol > v.69(1) > 1007610

Choi, Moon, Kim, Kim, Lee, Jung, Yoon, Lee, Park, and Han: Second Korean Guideline for the Management of Ulcerative Colitis

Abstract

Ulcerative colitis (UC) is a chronic inflammatory bowel disorder characterized by a relapsing and remitting course. The direct and indirect costs of the treatment of UC are high, and the quality of life of patients is reduced, especially during exacerbation of the disease. The incidence and prevalence of UC in Korea are still lower than those of Western countries, but have been rapidly increasing during the past decades. Various medical and surgical therapies, including biologics, are currently used for the management of UC. However, many challenging issues exist, which sometimes lead to differences in practice between clinicians. Therefore, the Inflammatory Bowel Disease Study Group of the Korean Association for the Study of Intestinal Diseases established the first Korean guideline for the management of UC in 2012. This is an update of the first guideline. It was generally made by the adaptation of several foreign guidelines as was the first edition, and encompasses treatment of active colitis, maintenance of remission, and indication of surgery for UC. The specific recommendations are presented with the quality of evidence and classification of recommendations.

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Table 1.
Nine Guidelines Selected for Adaptation13–21
No. Title Country Journal Year Volume/Page
1 Ulcerative colitis: management in adults, children and young people UK National Clinical 2013  
      Guideline Centre    
2 Treatment of hospitalized adult patients with severe ulcerative colitis: Toronto consensus statements Canada American Journal of Gastroenterology 2012 107/179–194
3 Clinical practice guidelines for the medical management of nonhospitalized ulcerative colitis: the Toronto consensus Canada Gastroenterology 2015 148/1035–1058
4 The London position statement of the World Congress of Gastroenterology on Biological Therapy for IBD with the European Crohn's and Colitis Organization: when to start, when to stop, which drug to choose, and how to predict response? World Congress of Gastroenterology American Journal of Gastroenterology 2011 106/199–212
5 The London position statement of the World Congress of Gastroenterology on Biological Therapy for IBD with the European Crohn's and Colitis Organisation: safety World Congress of Gastroenterology American Journal of Gastroenterology 2011 106/1594–1602
5 Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 2: current management EU Journal of Crohn's and Colitis 2012 6/991–1030
7 Therapeutic guidelines on ulcerative colitis: a GRADE methodology based effort of GETECCU Spain Gastroenterologia y Hepatologia 2013 36/104–114
8 Guidelines for the management of inflammatory bowel disease in adults UK Gut 2011 60/571–607
9 The Italian Society of Gastroenterology (SIGE) and the Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD) Clinical Practice Guidelines: The use of tumor necrosis factor-alpha antagonist therapy in inflammatory bowel disease Italy Digestive and Liver Disease 2011 43/1–20.
Table 2.
Definitions or Implications of the Levels of Evidence and Recommendations
Level Definitions/implications
Quality of evidence  
 High We are very confident that the true effect lies close to that of the estimate of the effect.
 Moderate We are moderately confident about the effect estimate: the true effect is most likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
 Low Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
 Very low We have very little confidence in the effect estimate: the true effect is most likely to be substantially different from the estimate of the effect.
Classification of recommendations
 Strong Most patients should receive the recommended course of action.
 Weak Clinicians should recognize that different choices would be appropriate for different patients and that they must help patients to arrive at a management decision consistent with their values and preferences.
Table 3.
Truelove and Witts' Score for Clinical Severity of Ulcerative Colitis11,27
  Mild a Moderate Severe b
(1) Frequency of defection 4 times or less Intermediate between mild and severe 6 times or more
(2) Bloody stool (−) or (+)   (+++)
(3) Fever c Absent   37.5° C or higher
(4) Tachycardia d Absent   90/min or more
(5) Anemia Absent   Hb 10 g/dL or less
(6) ESR Normal   30 mm/h or more

Hb, hemoglobin; ESR, erythrocyte sedimentation rate.

a Rated as “mild” when all 6 criteria are satisfied.

b Rated as “severe” when criteria (1) and (2), and either of systemic symptoms (3) and (4) are satisfied, and at least 4 of the 6 criteria are satisfied.

c Fever: mean evening temperature of >37.5 C, or a temperature of ≥37.8 C at least 2 of 4 days.

d Tachycardia: mean pulse rate of >90/min.

Table 4.
Delivery System for 5-ASA8
5-ASA Delivery system
Azo-bond  
 Sulfasalazine (500 mg/tablet) Sulfapyridine carrier
 Olsalazine (250 mg/capsule) 5-ASA dimer
 Balsalazide (750 mg/capsule) 4-Amino-benzoyl-β-alanine
Controlled release  
 Pentasa® (500 mg or 1000 mg/tablet) Ethylcellulose-coated microgranules
pH 7-dependent  
 Asacol® (400 mg/tablet) Eudragit-S coating, dissolves at pH 7
pH 6-dependent  
 Salofalk® (250 mg/tablet) Eudragit-L coating, dissolves at pH 6
Composite (multimatrix, 1200 mg/tablet) Mezavant® (EU) Eudragit-S coating of hydrophilic polymer with some 5-ASA and lipophilic excipients encapsulating 5-ASA
 Lialda® (US)  

5-ASA, 5-aminosalicylic acid.

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