Management of ulcerative colitis: a clinical update

Abstract

The objective of this study was to evaluate the consensus of expert societies and published guidelines on the management of ulcerative colitis, and to compare with the experience of the authors, in order to standardize procedures that would help the reasoning and decision-making process of the physician. A search was performed in scientific literature, specifically in electronic databases: Medline/Pubmed, SciELO, EMBASE and Cochrane, and the following descriptors were used: ulcerative colitis, acute colitis, clinical treatment, surgery and randomized trial. It can be concluded that the goals of therapy in ulcerative colitis are clinical and endoscopic remission, deep, sustained remission without corticosteroids, prevention of hospitalizations and surgeries, and improved quality of life. The surgical indications are reserved for selected cases, ranging from medical intractability, complications (severe refractory acute colitis, toxic megacolon, perforation and hemorrhage) and malignancy. Information in this review article must be submitted to evaluation and criticism of the specialist responsible for the conduct to be followed, in the face of his/her reality and the clinical status of each patient.The degree of recommendation and strength of evidence were based using the GRADE system (The Grades of Recommendation, Assessment, Development, and Evaluation) described below:1. A: Experimental or observational studies of higher consistency.2. B: Experimental or observational studies of lower consistency.3. C: Case reports (non-controlled studies).4. D: Opinion without critical evaluation, based on consensus, physiological studies or animal models.

Revisiting Inflammatory Bowel Disease: Pathology, Treatments, Challenges and Emerging Therapeutics Including Drug Leads from Natural Products

“…UC causes inflammation and ulceration of the inner lining of the colon and rectum (the large bowel). There is no gender predominance in UC, and the peak age of disease onset is between ages 30-40 years [27]. Symptoms usually include diarrhea, abdominal pain, fatigue, loss of appetite and weight, and anemia.…”

Ulcerative Colitis: the Role of Elective and Emergency Surgery

“…Their overall incidence in UC is approximately 10% [15,24]. The clinical presentation of both of these clinical entities includes acute onset of bloody diarrhoea, anorexia, abdominal tenderness, and colicky pain [25]. In order for a patient to be considered as toxic at least two of the following must be present: fever greater than 38.6°C, tachycardia, leucocytosis greater than 10.500/L and hypoalbuminemia (<3.0 g/100 mL), however the distinguishing feature of toxic megacolon is a total or segmental non-obstructive dilatation of the colon (>5.5 cm) [24][25][26].…”

“…The clinical presentation of both of these clinical entities includes acute onset of bloody diarrhoea, anorexia, abdominal tenderness, and colicky pain [25]. In order for a patient to be considered as toxic at least two of the following must be present: fever greater than 38.6°C, tachycardia, leucocytosis greater than 10.500/L and hypoalbuminemia (<3.0 g/100 mL), however the distinguishing feature of toxic megacolon is a total or segmental non-obstructive dilatation of the colon (>5.5 cm) [24][25][26]. Subtotal colectomy with temporary end ileostomy is considered to be the operation of choice, as the preservation of the rectum safeguards the possibility of restoring the continuity of the intestinal tract with an ileal-pouch rectal anastomosis [23].…”

Baccharis dracunculifolia DC Hydroalcoholic Extract Improves Intestinal and Hippocampal Inflammation and Decreases Behavioral Changes of Colitis Mice

“…The symptoms of UC may include weight loss, abdominal pain, diarrhea, rectal bleeding, and fatigue, and when the disease is limited to the rectum, the symptoms are more related to fecal incontinence and urgency of defecation. In severe cases, episodes of vomiting, fever, anorexia, and abdominal distension can occur [ 3 , 4 ]. In addition to these symptoms, patients with UC are at higher risk of developing colorectal cancer [ 5 ] and are more likely to develop psychological conditions such as anxiety and depression and have impaired social interactions or careers [ 6 ].…”