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April 3, 2020
Ulcerative Colitis Practice Guideline Released by the American Gastroenterological Association: Recommendations for the medical management of adult outpatients with moderate to serve ulcerative colitis (UC) and hospitalized adult patients with acute severe UC (ASUC) were released by the AGA in January 2020. The guidelines focus on use of immunomodulators, biologic agents, and small molecules for remission induction and maintenance in moderate to severe UC and for reducing the risk of colectomy for ASUC. The guideline emphasizes the need for shared decision making between healthcare providers and patients to ensure that patient preferences and values are considered.
Upon completion of the chapter, the reader will be able to:
Characterize the pathophysiologic mechanisms underlying inflammatory bowel disease (IBD).
Recognize the signs and symptoms of IBD, including major differences between ulcerative colitis (UC) and Crohn disease (CD).
Identify appropriate therapeutic outcomes for patients with IBD.
Describe pharmacologic treatment options for patients with acute or chronic symptoms of UC and CD.
Create a patient-specific drug treatment plan based on symptoms, severity, and location of UC or CD.
Recommend appropriate monitoring parameters and patient education for drug treatments for IBD.
The term inflammatory bowel disease (IBD) encompasses ulcerative colitis (UC) and Crohn disease (CD). Both disorders are associated with acute and chronic inflammation of the gastrointestinal (GI) tract. Differences exist between UC and CD with regard to regions of the GI tract that may be affected and the distribution and depth of intestinal inflammation. Patients with IBD may also develop inflammation involving organs other than the GI tract, known as extraintestinal manifestations. Symptoms of IBD are associated with significant morbidity, reduction in quality of life, and costs to the health care system.1–6
EPIDEMIOLOGY AND ETIOLOGY
IBD is most common in Western countries such as the United States and Northern Europe. The age of initial presentation is bimodal, with patients typically diagnosed between the ages of 20 and 40 or 60 and 80 years. Approximately 1.6 million Americans have UC or CD. Up to 70,000 new cases of IBD are diagnosed in the United States each year.3
Men and women are approximately equally affected by IBD in Western countries.6 In general, whites are affected more often than blacks, and persons of Jewish descent are also at higher risk. The incidence of IBD is 10 to 40 times greater in individuals with a first-degree relative who has IBD compared with the general population.4,5,7 A positive family history may be more of a contributing factor for development of CD than UC.7–9
The cause of IBD is not fully understood. Dysregulation of the inflammatory response within the GI tract in response to ...