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Second European evidence-based consensus on the diagnosis and management of ulcerative colitis Part 2: Current management
Abstract
### 5.1 General When deciding the appropriate treatment strategy for active ulcerative colitis one should consider the activity, distribution (proctitis, left-sided, extensive1), and pattern of disease. The disease pattern includes relapse frequency, course of disease, response to previous medications, side-effect profile of medication and extra-intestinal manifestations. The age at onset and disease duration may also be important factors. #### 5.1.1 Disease activity The principal disease activity scoring systems used in clinical trials are covered in Section 1.2 and have been comprehensively reviewed.2 However there are some practical points that are relevant for routine clinical use. For example, it is most important to distinguish patients with severe ulcerative colitis necessitating hospital admission from those with mild or moderately active disease who can generally be managed as outpatients. The simplest, best validated and most widely used index for identifying severe UC remains that of Truelove and Witts3: any patient who has a bloody stool frequency ≥ 6/day and a tachycardia (> 90 bpm), or temperature > 37.8 °C, or anaemia (haemoglobin 30 mm/h) has severe ulcerative colitis (Table 1.3). Only one additional criterion in addition to the bloody stool frequency ≥ 6/day is needed to define a severe attack.4,5 It should be standard practice to confirm the presence of active colitis by sigmoidoscopy before starting treatment. Flexible sigmoidoscopy and biopsy may exclude unexpected causes of symptoms that mimic active disease such as cytomegalovirus colitis, rectal mucosal prolapse, Crohn's disease, malignancy, or even irritable bowel syndrome and haemorrhoidal bleeding. There may be a significant overlap between other diseases that mimic ulcerative colitis and the broad spectrum of UC damage.6,7 In addition, all patients with active disease require stool cultures with Clostridium difficile toxin assay to exclude enteric infection. Patients with an appropriate …
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“E. coli Nissle is now considered an effective alternative to 5-aminosalicylate for remission maintenance in UC.73”
From The gut microbiota and host health: a new clinical frontier (2016) · cites this paper as [73]
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Metadata
- Authors
- Dignass, A., Lindsay, J. O., Sturm, A., Windsor, A., Colombel, J.-F., Allez, M., D'Haens, G., D'Hoore, A., Mantzaris, G., Novacek, G., Öresland, T., Reinisch, W., Sans, M., Stange, E., Vermeire, S., Travis, S., & Van Assche, G.
- Affiliations
- Agaplesion Markus Hospital (DE)
- ORCID
- Venue
- Journal of Crohn's and Colitis
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-12-01
- Volume
- 6
- Issue
- 10
- Pages
- 991-1030
- ISSN
- 1873-9946 (ISSN-L)
- 1876-4479
- OpenAlex
- W2120522488
- Cited by
- 1,548
- References
- 495
- Citations by year
- 2026: 11 · 2025: 25 · 2024: 53 · 2023: 76 · 2022: 115 · 2021: 152 · 2020: 168 · 2019: 161 · 2018: 156 · 2017: 146 · 2016: 165 · 2015: 136 · 2014: 121 · 2013: 57 · 2012: 4
- FWCI
- 60.30
- Type
- journal article
- Language
- en
- Update notices
- expression_of_concern (2022-01-24)
- Open access
- closed
- Locations
- Journal of Crohn s and Colitis (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Inflammatory Bowel Disease
- Health Sciences › Medicine › Ophthalmology › Ocular Diseases and Behçet’s Syndrome
- Health Sciences › Medicine › Gastroenterology › Microscopic Colitis
- Keywords
- ulcerative colitis, disease activity assessment
- MeSH terms
- Adrenal Cortex Hormones, Anti-Inflammatory Agents, Non-Steroidal, Colitis, Ulcerative, Humans, Immunosuppressive Agents, Tumor Necrosis Factor-alpha, Proctocolectomy, Restorative, Maintenance Chemotherapy
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