Mild-Moderate Ulcerative Colitis Management

Publication Date: February 1, 2019

Key Points

Key Points

  • UC is a chronic inflammatory bowel disease with onset most frequently in young adulthood. Most patients with UC have a mild-to-moderate course characterized by periods of activity or remission. Over 90% of patients with UC are treated with 5-aminosalicylates (5-ASA) shortly after disease diagnosis, and most who achieve clinical remission with these medications continue them for maintenance of remission.
    • The minority of patients with UC require immunomodulators or biologic therapies for disease control.
  • For this guideline, mild-moderate UC was defined as patients with fewer than 4-6 bowel movements per day, mild-moderate rectal bleeding, absence of constitutional symptoms, low overall inflammatory burden, and absence of features suggestive of high inflammatory activity based upon Truelove and Witt’s criteria (Truelove SC, Witts LJ. Br Med J 1955;2:1041-8) and the Mayo Clinic score (https://www.mdcalc.com/mayo-score-disease-activity-index-dai-ulcerative-colitis).
  • Although disease activity exists on a spectrum, patients in the mild-moderate category who have more frequent bowel movements, more prominent rectal bleeding or greater overall inflammatory burden should be considered to have moderate disease.
  • The mainstay of therapy for mild-moderate UC is the 5-ASA class of medications including sulfasalazine, mesalamine and diazo-bonded 5-ASA (Table 2).

Treatment

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