Ulcerative colitis is a relapsing and remitting disease that is increasing in incidence and prevalence. Management aims to achieve rapid resolution of symptoms, mucosal healing and improvement in a patient's quality of life. 5-aminosalicylate acid medications remain the first-line treatment for mild to moderate disease. In the event of suboptimal response to these medications, escalation to immunosuppressive medications and biologics may be necessary. Importantly, despite best medical therapy, surgery may be required in a proportion of patients. The future will likely see an array of new therapeutic options for those with ulcerative colitis with the potential for a more personalised treatment approach.

High-quality data remains scarce in terms of optimal management strategies in the elderly inflammatory bowel disease (IBD) population. Indeed, available trials have been mostly retrospective, of small sample size, likely owing to under-representation of such a population in the major randomized controlled trials. However, in the last five years, there has been a steady increase in the number of published trials, helping clarify the estimated benefits and toxicity of the existing IBD armamentarium. In the Everhov trial, prescription strategies were recorded over an average follow-up of 4.2 years. A minority of elderly IBD patients (1%-3%) were treated with biologics within the five years following diagnosis, whilst almost a quarter of these patients were receiving corticosteroid therapy at year five of follow-up, despite its multiple toxicities. The low use of biologic agents in real-life settings likely stems from limited data suggesting lower efficacy and higher toxicity. This minireview will aim to highlight current outcome measurements as it portends the elderly IBD patient, as well as summarize the available therapeutic strategies in view of a growing body of evidence.

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The gut microbiome has been implicated in a range of diseases and there is a rapidly growing understanding of this ecosystem’s importance in inflammatory bowel disease. We are yet to identify a single microbe that causes either ulcerative colitis (UC) or pouchitis, however, reduced microbiome diversity is increasingly recognised in active UC. Manipulating the gut microbiome through dietary interventions, prebiotic and probiotic compounds and faecal microbiota transplantation may expand the therapeutic landscape in UC. Specific diets, such as the Mediterranean diet or diet rich in omega-3 fatty acids, may reduce intestinal inflammation or potentially reduce the risk of incident UC. This review summarises our knowledge of gut microbiome therapies in UC and pouchitis.

Background/Aims During the COVID-19 pandemic, inflammatory bowel disease clinics were converted to telephone clinics at St. Mark's Hospital in Harrow. This study assessed the response of patients and clinicians to remote telemedicine services, with the view of establishing whether there was scope for increasing the role of remote services in the inflammatory bowel disease clinics. Methods Clinicians administered a questionnaire to patients at the end of their appointments regarding their opinions on the telephone clinic format. Eleven questions used a 5-point Likert scale while a further three questions asked the patient for their comments on future clinics. Clinicians provided information about the patients' condition and management, as well as their own comments. Results Overall satisfaction with telephone clinics was found to be high among patients and clinicans, with many feeling that telephone clinics were more convenient. In total, 94.3% of patients said they would prefer either all telephone or a mix of phone and face-to-face clinics in the future. However, some patients felt that it was more complicated to have blood or stool tests done and roughly a quarter of patients were concerned that something could be missed without a physical examination. Conclusions High patient satisfaction can be achieved by delivering a mix of telephone, video and face-to-face clinics. In certain clinical situations, face-to-face clinics would be appropriate, such as patients with active diseases and first appointments. The pandemic is an opportunity respond to patients' preferences by increasing the range of remote care options.