AGA releases guideline for Mx of mild-to-moderate ulcerative
A new clinical guideline from the American Gastroenterological Association (AGA) published in Gastroenterology addresses the medical management of these patients, focusing on use of both oral and topical 5-aminosalicylates (5-ASA) medications, rectal corticosteroids and oral budesonide, to promote high-quality care for ulcerative colitis (UC) patients.

Mild-to-moderate UC was defined as patients with fewer than four to six bowel movements per day, mild or moderate rectal bleeding, absence of constitutional symptoms, low overall inflammatory burden, and absence of features suggestive of high inflammatory activity. Although disease activity exists on a spectrum, patients in the mild-to-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 recommendations are:-

• Use either standard dose mesalamine (2-3 grams/day) or diazo-bonded 5-ASA rather than low dose mesalamine, sulfasalazine or no treatment in patients with extensive mild-moderate UC. (Strong recommendation)

• In patients with extensive or left-sided mild-moderate UC, add rectal mesalamine to oral 5-ASA. (Conditional recommendation)

• In patients with mild-moderate UC with suboptimal response to standard-dose mesalamine or diazo-bonded 5-ASA or with moderate disease activity, use high-dose mesalamine (>3 g/d) with rectal mesalamine. (Conditional recommendation)

• In patients with mild-moderate UC being treated with oral mesalamine, use once-daily dosing rather than multiple times per day dosing. (Conditional recommendation)

• In patients with mild-moderate UC, use standard-dose oral mesalamine or diazo-bonded 5-ASA, rather than budesonide MMX or controlled ileal-release budesonide for induction of remission. (Conditional recommendation)

• In patients with mild-moderate ulcerative proctosigmoiditis or proctitis, use mesalamine enemas (or suppositories) rather than oral mesalamine. (Conditional recommendation)

• In patients with mild-moderate ulcerative proctosigmoiditis who choose rectal therapy over oral therapy, use mesalamine enemas rather than rectal corticosteroids. (Conditional recommendation)

• In patients with mild-moderate ulcerative proctitis who choose rectal therapy over oral therapy, use mesalamine suppositories. (Strong recommendation)

• In patients with mild-moderate ulcerative proctosigmoiditis or proctitis being treated with rectal therapy who are intolerant of or refractory to mesalamine suppositories, use rectal corticosteroid therapy rather than no therapy for induction of remission. (Conditional recommendation)


About ACG
The American College of Gastroenterology (ACG) is a Bethesda, Maryland–based medical association of gastroenterologists.The association was founded in 1932 and holds annual meetings and regional postgraduate continuing education courses, establishes research grants. The ACG provides its members with scientific information on digestive health and the etiology, symptomatology and treatment of GI disorders.


Note: This list is a brief compilation of some of the key recommendations included in the Guidelines and is not exhaustive and does not constitute medical advice. Kindly refer to the original publication here: https://pxmd.co/vz6o8
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