106 The aims of UC treatment are to induce remission, maintain remission as well as monitor, prevent and manage complications (disease, drugs, and surgery) and improve well-being. Level of agreement: a-94%, b-6%, c-0%, d-0%, e-0% Quality of evidence: III Classification of recommendation: C The goals of management of UC are to induce remission, maintain remission, prevent complications and improve quality of life. The treatment of UC depends upon the

activity of the disease (active phase, remission phase), extent of the disease (proctitis, proctosigmoiditis, left sided colitis and pancolitis), and dependency on steroid, and needs to be individualized for each patient.4,5,107 In patients with mild distal UC, 5-ASA given topically and/or orally is the treatment of choice. Level of agreement: a-94%, b-6%, c-0%, d-0%, e-0% Quality of evidence: I Classification of recommendation: A Ulcerative colitis distal to the splenic flexure PD0332991 nmr may be treated topically with suppositories, enemas, foams and

gel.108,109 The choice of preparation PF-562271 clinical trial depends on the extent of the colitis (for example, suppositories are suitable for proctitis and enemas can reach the splenic flexure). This route of administration delivers a higher dose directly to the affected mucosa and reduced systemic drug absorption may minimize systemic adverse effects.108–110 Patient preference regarding route of drug delivery should also be considered. There is no high quality evidence for treatment choice in Asian populations, and extrapolation from Western data is necessary. 5-ASA enemas and suppositories are effective first-line therapies for patients with distal UC and ulcerative proctitis.111 Combined oral and topical 5-ASA is superior to oral mesalamine alone for patients with distal colitis.112,113 There is no dose-response to MCE公司 topical therapy above a dose of 1 g mesalamine daily. Clinical (and endoscopic) remission

can occur in up to 64% within 2 weeks. Oral mesalamine is also effective in the treatment of active distal colitis and may be preferred for convenience and compliance.111,112,114 For maintenance treatment for distal colitis, oral and/ or topical mesalamine are effective.115,116 Topical corticosteroids can be used as second line therapy for patients intolerant to- or failed-topical mesalamine.108,114 Patients who have failed to improve on a combination of oral mesalamine with either topical mesalamine or topical corticosteroids may be treated with oral prednisolone. In acute severe colitis, intravenous (IV) corticosteroid is the treatment. Level of agreement: a-94%, b-6%, c-13%, d-0%, e-0% Quality of evidence: IIA Classification of recommendation: B The mainstay of treatment of acute severe exacerbation of UC is IV corticosteroids,5,117 at a dose of, for example, 48–60 mg/day methylprednisolone or 300–400 mg/day daily hydrocortisone.