Cited by 1,548Inflammatory Bowel DiseaseOcular Diseases and Behçet’s SyndromeMicroscopic Colitis

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Second European evidence-based consensus on the diagnosis and management of ulcerative colitis Part 2: Current management

Dignass, Axel, Lindsay, James O., Sturm, Andreas, Windsor, Alastair, Colombel, Jean-Frederic, Allez, Mathieu, D'Haens, Gert, D'Hoore, André, Mantzaris, Gerassimos, Novacek, Gottfried, Öresland, Tom, Reinisch, Walter, Sans, Miquel, Stange, Eduard, Vermeire, Severine, Travis, Simon, Van Assche, Gert·2012·Journal of Crohn's and Colitis

DOI 10.1016/j.crohns.2012.09.002

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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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Ferrante, 2009, Corticosteroids but not infliximab increase short-term postoperative infectious complications in patients with ulcerative colitis, Inflamm Bowel Dis, 15, 1062, 10.1002/ibd.20863 · DOI
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Clinical Implications of Dietary Probiotic Supplement (Associated with L-Glutamine and Biotin) in Ulcerative Colitis Patients’ Body Composition and Quality of Life
Pavel, F. M., BUNGAU, S. G., Ţiţ, D. M., Ghitea, T. C., Marin, R. C., Radu, A.-F., Moleriu, R. D., Ilias, T. I., Bustea, C., & Vesa, C. M. (2023) · Nutrients · doi:10.3390/nu15245049 · Cited by 9
A Review on Nanosystem-Based Delivery of Tofacitinib for Enhanced Treatment of Autoimmune Diseases and Inflammation
Nguyen, T., & Duong, V. (2024) · BioNanoScience · doi:10.1007/s12668-024-01373-5 · Cited by 9
Changes in the clinical course and prognosis of ulcerative colitis in Chinese populations: a retrospective cohort study
Liu, X., Yang, Q., Diao, N., Tang, J., Huang, Z., Gao, X., & Chao, K. (2024) · Intestinal Research · doi:10.5217/ir.2023.00106 · Cited by 9
Patients’ Preference of Topical Therapy for Ulcerative Colitis in Japan: A Web-based 3T Survey
Yanai, S., Toya, Y., Nakamura, S., & Matsumoto, T. (2020) · Crohn s & Colitis 360 · doi:10.1093/crocol/otaa030 · Cited by 9
The Role of Inflammation in Anal Cancer
Selimagić, A., Đozić, A., Husić-Selimović, A., Tucaković, N., Ćehajić, A., Šubo, A., Spahic, A., & Vanis, N. (2022) · Diseases · doi:10.3390/diseases10020027 · Cited by 9
The Potential of Natural Oils to Improve Inflammatory Bowel Disease
Zhou, Y., Wang, D., Duan, H., Zhou, S., Guo, J., & Yan, W. (2023) · Nutrients · doi:10.3390/nu15112606 · Cited by 9
Treatment of Patients with Mild to Moderate Ulcerative Colitis: A Middle East Expert Consensus
Awadhi, S. A., Alboraie, M. A. A., Albaba, E. A. M., Almutairdi, A. A., Alsaad, M., Azzam, N. A., Barakat, H., D’Amico, F., Danese, S., Kady, M. E., et al. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12216929 · Cited by 9
How fast up the ladder? Factors associated with immunosuppressive or anti-TNF therapies in IBD patients at early stages: results from a population-based cohort
Ott, C., Takses, A., Obermeier, F., Schnoy, E., Salzberger, B., & Müller, M. (2014) · International Journal of Colorectal Disease · doi:10.1007/s00384-014-2002-z · Cited by 9
Electrochemiluminescence immunoassay method underestimates cortisol suppression in ulcerative colitis patients treated with oral prednisone
Manguso, F. (2014) · World Journal of Gastroenterology · doi:10.3748/wjg.v20.i31.10895 · Cited by 9
Glucocorticoid therapy for gastrointestinal diseases
Triadafilopoulos, G. (2014) · Expert Opinion on Drug Safety · doi:10.1517/14740338.2014.904852 · Cited by 9
The role of Budesonide-MMX in active ulcerative colitis
Gionchetti, P., Praticò, C., Rizzello, F., Calafiore, A., Capozzi, N., Campieri, M., & Calabrese, C. (2014) · Expert Review of Gastroenterology & Hepatology · doi:10.1586/17474124.2014.887437 · Cited by 9
A retrospective analysis of 20-year data of the surgical management of ulcerative colitis patients in Taiwan: a study of Taiwan Society of Inflammatory Bowel Disease
Lin, C., Wei, S., Lin, B., Tsai, W., Chen, J.-S., Hsu, T., Lin, W.-C., Huang, T.-Y., Chao, T., Lin, H., et al. (2016) · Intestinal Research · doi:10.5217/ir.2016.14.3.248 · Cited by 9
Effectiveness of anti-tumour necrosis factor-α therapy in Danish patients with inflammatory bowel diseases.
Bank, S., Andersen, P. S., Burisch, J. M., Pedersen, N. K., Roug, S., Galsgaard, J., Turino, S. Y., Brodersen, J. B., Rashid, S., Avlund, S. H., et al. (2015) · PubMed · Cited by 9
Continuous Clinical Response Is Associated With a Change of Disease Course in Patients With Moderate to Severe Ulcerative Colitis Treated With Golimumab
Reinisch, W., Colombel, J., Gibson, P. R., Rutgeerts, P. J., Sandborn, W. J., Tarabar, D. K., Huyck, S. B., Khalifa, A. M., Marano, C. W., Philip, G., et al. (2018) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izy229 · Cited by 9
Self-citation
Time to include patients with ulcerative proctitis in clinical trials
de Chambrun, G. P., Danese, S., & Peyrin‐Biroulet, L. (2019) · The Lancet. Gastroenterology & hepatology · doi:10.1016/s2468-1253(19)30341-3 · Cited by 9
A Prospective Multicenter Study on the Prevalence of Fructose Malabsorption in Patients with Chronic Inflammatory Bowel Disease
Helwig, U., Koch, A. K., Reichel, C., Jessen, P., Büning, J., Schreiber, S., Langhorst, J., & on behalf of the, G. I. S. G. (2020) · Digestion · doi:10.1159/000507851 · Cited by 9
NUDT15 genotyping during azathioprine treatment in patients with inflammatory bowel disease: implications for a dose-optimization strategy
Xu, Y., Qiao, Y., Li, H.-Y., Zhou, M., Cai, C., Shen, J., & Ran, Z. (2020) · Gastroenterology report · doi:10.1093/gastro/goaa021 · Cited by 9
PREDICTORS OF COLECTOMY IN PATIENTS WITH «EXTREMELY SEVERE» ULCERATIVE COLITIS
Иванович, А. С., Шапина, М. В., Веселов, В. В., Vardanyan, A. V., Mingazov, A. F., & Пономаренко, А. А. (2020) · Koloproktologia · doi:10.33878/2073-7556-2020-19-3-37-48 · Cited by 9
Integrated Traditional Chinese and Western medicine for ulcerative colitis with diabetes
Lan, Y.-Z., Bai, Y., & Zhu, X.-D. (2021) · Medicine · doi:10.1097/md.0000000000024444 · Cited by 9
Efficacy and Safety of Vedolizumab in Management of Moderate to Severe Ulcerative Colitis: A Systematic Review
Bhandari, R., Ogeyingbo, O. D., Kareem, R., Gyawali, M., Venkatesan, N., Ahmed, R., Botleroo, R. A., & Elshaikh, A. O. (2021) · Cureus · doi:10.7759/cureus.17729 · Cited by 9
Model-Informed Precision Dosing during Infliximab Induction Therapy Reduces Variability in Exposure and Endoscopic Improvement between Patients with Ulcerative Colitis
Faelens, R., Wang, Z., Bouillon, T. W., Declerck, P. J., Ferrante, M., Vermeire, S., & Dreesen, E. (2021) · Pharmaceutics · doi:10.3390/pharmaceutics13101623 · Cited by 9
Self-citation
Persistence of treatment in patients with ulcerative colitis who responded to tofacitinib therapy: data from the open‐label, long‐term extension study, OCTAVE open
Panaccione, R., Abreu, M. T., Lazariciu, I., Mundayat, R., Lawendy, N., Salese, L., Woolcott, J. C., Sands, B. E., & Chaparro, M. (2022) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.16848 · Cited by 9
Different Profile of Efficacy of Thiopurines in Ulcerative Colitis and Crohnʼs Disease
Rispo, A., Testa, A., Palma, G. D. D., Donetto, S., Diaferia, M., Musto, D., Nardone, O. M., Maione, F., Caporaso, N., & Castiglione, F. (2015) · Inflammatory Bowel Diseases · doi:10.1097/mib.0000000000000538 · Cited by 9
Distinct Kinetics in the Frequency of Peripheral CD4+ T Cells in Patients with Ulcerative Colitis Experiencing a Flare during Treatment with Mesalazine or with a Herbal Preparation of Myrrh, Chamomile, and Coffee Charcoal
Langhorst, J., Frede, A., Knott, M., Pastille, E., Buer, J., Dobos, G., & Westendorf, A. M. (2014) · PLoS ONE · doi:10.1371/journal.pone.0104257 · Cited by 9
Rectocolite hémorragique : conduite diagnostique et prise en charge thérapeutique
Prieux‐Klotz, C., Barret, M., Dhooge, M., Oudjit, A., Chaussade, S., Coriat, R., & Abitbol, V. (2014) · La Presse Médicale · doi:10.1016/j.lpm.2014.06.025 · Cited by 9
Etrolizumab for ulcerative colitis: the new kid on the block?
Makker, J., & Hommes, D. W. (2016) · Expert Opinion on Biological Therapy · doi:10.1517/14712598.2016.1158807 · Cited by 9
Predictors of tissue healing in ulcerative colitis patients treated with anti-TNF
Viazis, N., Giakoumis, M., Bamias, G., Goukos, D., Koukouratos, T., Katopodi, K., Karatzas, P. S., Triantos, C. K., Tsolias, C., Theocharis, G. J., et al. (2016) · Digestive and Liver Disease · doi:10.1016/j.dld.2016.10.008 · Cited by 9
Self-citation
Detection and characterization of murine colitis and carcinogenesis by molecularly targeted contrast-enhanced ultrasound
Brückner, M., Heidemann, J., Nowacki, T. M., Cordes, F., Stypmann, J., Lenz, P., Gohar, F., Lügering, A., & Bettenworth, D. (2017) · World Journal of Gastroenterology · doi:10.3748/wjg.v23.i16.2899 · Cited by 9
Genetic associations with adverse events from anti-tumor necrosis factor therapy in inflammatory bowel disease patients
Lew, D., Yoon, S. M., Yan, X., Robbins, L., Haritunians, T., Liu, Z., Li, D., & McGovern, D. P. B. (2017) · World Journal of Gastroenterology · doi:10.3748/wjg.v23.i40.7265 · Cited by 9
Management of acute severe ulcerative colitis in Spain: A nationwide clinical practice survey
Rodríguez–Lago, I., Ferreiro‐Iglesias, R., Nos, P., & Gisbert, J. P. (2019) · Gastroenterología y Hepatología (English Edition) · doi:10.1016/j.gastre.2018.09.001 · Cited by 9
Nucleoside diphosphate-linked moiety X-type motif 15 R139C genotypes impact 6-thioguanine nucleotide cut-off levels to predict thiopurine-induced leukopenia in Crohn’s disease patients
Xia Shuang, Z. H. U., Chao, K., Li, M., Xie, W., Zheng, H., Zhang, J., Hu, P., Huang, M., Gao, X., & Wang, X. (2019) · World Journal of Gastroenterology · doi:10.3748/wjg.v25.i38.5850 · Cited by 9
Switching to a Second Thiopurine in Adult and Elderly Patients With Inflammatory Bowel Disease: A Nationwide Study From the ENEIDA Registry
Calafat, M., Mañosa, M., Mesonero, F., Guardiola, J., Mínguez, M., Nos, P., Vera, I., Taxonera, C., Iglesias, E. L., Ricart, E., et al. (2020) · Journal of Crohn s and Colitis · doi:10.1093/ecco-jcc/jjaa055 · Cited by 9
Use of mesenchymal stem cells in the combination therapy of ulcerative colitis
Knyazev, O. V., Parfenov, A. I., Георгиевич, К. А., & Болдырева, О. Н. (2016) · Terapevticheskii arkhiv · doi:10.17116/terarkh201688244-48 · Cited by 9
Topical Therapy in Ulcerative Colitis: Always a Bridesmaid but Never a Bride?
Ghosh, S. K., & Daperno, M. (2015) · Gastroenterology · doi:10.1053/j.gastro.2015.02.038 · Cited by 9
Long-term outcomes of cyclosporin induction and ustekinumab maintenance combination therapy in patients with steroid-refractory acute severe ulcerative colitis
Vitali, F., Räth, T., Klenske, E., Voegele, A.-L., Ganzleben, I., Zundler, S., Strobel, D. D., Geppert, C. E., Hartmann, A., Neurath, M. F., et al. (2023) · Therapeutic Advances in Gastroenterology · doi:10.1177/17562848231218555 · Cited by 8
The effect of anti-TNF drugs on the intestinal microbiota in patients with spondyloarthritis, rheumatoid arthritis, and inflammatory bowel diseases
Ciccia, F., Dussias, N. K., Gandolfo, S., Rizzello, F., & Gionchetti, P. (2024) · Rheumatology and Immunology Research · doi:10.1515/rir-2024-0003 · Cited by 8
Post-hospitalization Short Versus Long Steroid Taper Strategies in Patients With Acute Severe Ulcerative Colitis: A Comparison of Clinical Outcomes
Alomari, M., Chadalavada, P. N., Afraz, S., AlGhadir-AlKhalaileh, M., Suarez, Z. K., Swartz, A., Rashid, M., Khazaaleh, S., Cohen, B. L., Rahman, A. U., et al. (2024) · Crohn s & Colitis 360 · doi:10.1093/crocol/otae025 · Cited by 8
Burden of Bowel Urgency in Patients With Ulcerative Colitis and Crohn’s Disease: A Real-World Global Study
Atreya, R. N., Redondo, I., Streit, P., Protić, M., Hartz, S., Gurses, G., Knight, H., Barlow, S. G., Harvey, N., & Hunter, T. M. (2024) · Crohn s & Colitis 360 · doi:10.1093/crocol/otae047 · Cited by 8
Vedolizumab in Inflammatory Bowel Disease: West versus East
Debnath, P., & Rathi, P. M. (2021) · Inflammatory Intestinal Diseases · doi:10.1159/000512805 · Cited by 8
Adherence improvement in patients with ulcerative colitis: a multidisciplinary consensus document
Casellas, F., González‐Lama, Y., Vicens, D. G., García‐López, S., Muñoz, F., Sánchez, L. M., Camacho, L., Cábez, A., Fortes, M. D. P., Gómez, S., et al. (2021) · Revista Española de Enfermedades Digestivas · doi:10.17235/reed.2021.8130/2021 · Cited by 8
Real-world data on the infliximab biosimilar CT-P13 (Remsima®) in inflammatory bowel disease
Huguet, J. M., Cortés, X., Boscá-Watts, M. M., Aguas, M., Maroto, N., Martí, L., Amorós, C., & Paredes, J. M. R. (2021) · World Journal of Clinical Cases · doi:10.12998/wjcc.v9.i36.11285 · Cited by 8
Value-based care pathway for inflammatory bowel disease: a protocol for the multicentre longitudinal non-randomised parallel cluster IBD Value study with baseline period
van Linschoten, R. C. A., van Leeuwen, N., Nieboer, D., Birnie, E., Scherpenzeel, M., Verweij, K. E., de Jonge, V., Hazelzet, J. A., van der Woude, C. J., West, R. L., et al. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-050539 · Cited by 8
Beliefs About Medicines and Adherence to Treatment in Turkish Patients with Inflammatory Bowel Disease
Can, G., Yozgat, A., Tezel, A., Ünsal, G., & Soylu, A. R. (2022) · The Turkish Journal of Gastroenterology · doi:10.5152/tjg.2022.21355 · Cited by 8

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: Dignass, Axel
Lindsay, James O.
Sturm, Andreas
Windsor, Alastair
Mantzaris, Gerassimos
Novacek, Gottfried
Öresland, Tom
Reinisch, Walter
Sans, Miquel
Stange, Eduard
Travis, Simon
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
DOI: 10.1016/j.crohns.2012.09.002
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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Second European evidence-based consensus on the diagnosis and management of ulcerative colitis Part 2: Current management

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