ACG Clinical Guideline: Ulcerative Colitis in Adults
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CONCLUSIONS
UC is an idiopathic chronic inflammatory condition of the rectum
and colon, which presents with variable degrees of clinical
activity and severity and is associated with significant morbidity.
The appropriate management of patients with UC involves successful
induction of both clinical and endoscopic remission, followed
by the use of a steroid-free maintenance strategy. Choice of
therapy for UC is based on activity, severity, extent of inflammation,
and prognostic factors and may include oral, topical
(rectal), or systemic therapies, as well as surgery. When possible
and appropriate based on individual clinical factors, organ-specific
treatments can be used before systemic therapies. In general,
the induction therapy selected directs the choice of maintenance
therapy. Patients with UC are at an increased risk of CRC and
should undergo surveillance colonoscopy focused on identifying
and removing precancerous dysplasia. The evolution of technology
has resulted in more directly visualized approaches, removal
of endoscopically discrete lesions, and in select patients,
active surveillance rather than proctocolectomy.
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