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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Sorted by citations

Ulcerative colitis
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The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017
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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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