The American College of Gastroenterology published a clinical guideline on adult ulcerative colitis in The American Journal of Gastroenterology.
What you should know:
1. ACG updated the 2010 guideline due to ulcerative colitis disease management becoming "increasingly complex."
2. ACG addressed the diagnosis, treatment and management of adult UC patients with this guideline, including sections on the evaluation of hospitalized patients and on colorectal cancer prevention.
3. ACG published seven key concept statements and three recommendations for the diagnosis, assessment and prognosis of UC:
Concept statements:
- Physicians should suspect patients with hematochezia and urgency also have UC
- Physicians should exclude infectious etiologies when diagnosing a patient
- To confirm a UC diagnosis, a trained pathologist with a gastroenterology focus should conduct a colonoscopy with intubation of the ileum and then biopsy both affected and unaffected areas
- Disease extent should be categorized to include proctitis, left-sided colitis and extensive colitis
- If the terminal ileum is normal, physicians do not need to evaluate the stomach or small bowel by upper endoscopy with cross-sectional imaging, unless findings suggest proximal GI involvement or Crohn's disease.
- Disease severity definitions are needed to guide treatment decisions. ACG recommends definitions be based on patient-reported outcomes, inflammatory burden, disease course and disease impact
- Physicians can use fecal calprotectin in patients with UC to assess response to therapy and relapse
Recommendations, including strength of recommendation and evidence quality:
- Stool testing should be used to rule out Clostridium difficile in patients that could have UC, strong recommendation, very low quality of evidence
- Serologic antibody testing should not be used to establish or rule out a UC diagnosis, strong recommendation, very low quality of evidence
- Serologic antibody testing should not be used to determine the prognosis of UC, strong recommendation, very low quality of evidence.
4. ACG made a total of 49 graded recommendations and 54 key concept statements on the management of ulcerative colitis.
The entire guideline can be viewed by clicking here.