Update of the PANCCO clinical practice guidelines for the treatment of ulcerative colitis in the adult population.

Ulcerative colitis (US) is a chronic disease of unknown etiology. It is incurable and its clinical course is intermittent, characterized by periods of remission and relapse. The prevalence and incidence of the disease has been increasing worldwide. The update presented herein includes the participation of healthcare professionals, decision-makers, and a representative of the patients, all of whom declared their conflicts of interest. Answerable clinical questions were formulated, and the outcomes were graded. The information search was conducted on the Medline/PubMed, Embase, Epistemonikos, and LILACS databases, and covered grey literature sources, as well. The search was updated on November 30, 2020, with no restrictions regarding date or language. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification system was implemented to establish the strength of the recommendation and quality of evidence. A formal consensus was developed, based on the RAND/UCLA methodology and the document was peer reviewed. The short version of the Clinical Practice Guidelines for the Treatment of Ulcerative Colitis in the Adult Population is presented herein, together with the supporting evidence and respective recommendations. In mild-to-moderate UC, budesonide MMX is an option when treatment with 5-ASA fails, and before using systemic steroids. In moderate-to-severe UC, infliximab, adalimumab, vedolizumab, ustekinumab, and tofacitinib can be used as first-line therapy. If there is anti-TNF therapy failure, ustekinumab and tofacitinib provide the best results. In patients with antibiotic-refractory pouchitis, anti-TNFs are the treatment of choice.

Serological markers in inflammatory bowel disease: a review of their clinical utility.

BACKGROUND: Several antibodies, also called serological markers, are associated with specific forms, disease behavior and phenotype of inflammatory bowel disease (IBD). AIM: Summarize and analyze the evidence of the utility of serologic markers in IBD, making emphasis on their clinical utility and behavior between populations. MATERIAL AND METHODS: Relevant articles were located by computer-assisted search of PubMed (since January 1979 until December 2008). RESULTS: Anti-Saccharomyces cerevisiae antibodies (ASCA) and perinuclear Anti-neutrophil Cytoplasmic Antibodies (pANCA) are the best studied serological markers. Assessing both ASCA and pANCA allows a better differentiation of Crohn's disease (CD) from ulcerative colitis (UC) than by using the individual tests alone. The ASCA+/pANCA- phenotype is characteristic of CD, while the ASCA-/pANCA+ phenotype is found in UC. The interest on atypical ANCA is growing as it may be a useful tool to distinguish between different IBD forms. Newer markers derived from various microbial species of the gut and glycan markers are of interest as they offer new ways to stratify patients into serologic subgroups. These serological markers may act as prognostic indicators of the severity and behavior of IBD, but more studies are necessary to determine their utility. CONCLUSIONS: There is emerging evidence that combining serological markers may increase the accuracy of diagnosis of a specific form of IBD or its behavior, but the perfect assay or combination of antibodies has not been discovered. They have several limitations, therefore clinicians must be aware of the evidence on serological markers, interpret them with caution and always correlate with the clinical picture.

Antinuclear antibodies: a marker associated with steroid dependence in patients with ulcerative colitis.

BACKGROUND: The autoimmune phenomena and the autoantibody profile have acquired great importance in ulcerative colitis (UC). Few studies have explored antinuclear antibodies (ANAs) prevalence, but not its association with steroid dependence. We hypothesized that ANAs could be a factor associated to steroid dependence. METHODS: Ninety-seven consecutive patients with UC were included. ANA titers and staining patterns were determined by indirect immunofluorescence. Gender, age, follow-up time, C-reactive protein (CRP), disease extent, Mayo Score Activity Index, extraintestinal manifestations, and steroid dependence were analyzed in univariate and multivariate models. RESULTS: Ninety-seven patients were included and 49 (50.5%) were females; mean age was 41.7 +/- 22.2 years. Positivity for ANAs was encountered in 52 (53.5%) patients, and none for anti-dsDNA. The prevalence of ANAs was higher in steroid-dependent than in nonsteroid-dependent patients (77.8% versus 48.1%, P = 0.020; odds ratio [OR] = 3.8, 95% confidence interval [CI] 1.1-12.5), and in those with uveitis (100% versus 51.1%; P = 0.040) or pyoderma gangrenosum (100% versus 51.6%; P = 0.078). No association was observed with gender, age, CRP, disease extent, and Mayo Score Activity Index. The multiple regression analysis model showed an association between steroid dependence and ANAs (P = 0.033, OR = 3.9, 95% CI 1.4-14.9). CONCLUSIONS: ANAs are associated with steroid dependence in UC patients. Further studies are required to determine the role of ANAs as serological markers for prediction of steroid dependence in order to perform early therapeutic interventions with biological agents.

[Oral cyclosporine microemulsion for the treatment of severe chronic idiopathic ulcerative colitis refractory to intravenous steroids: experience in two cases.]. / Ciclosporina oral en microemulsión para el tratamiento de la colitis ulcerativa crónica idiopática grave refractaria a esteroides intravenosos; experiencia en dos casos.

There have been important advances in the treatment of severe forms of ulcerative colitis (UC). They include biologic therapy and immunomodulators such as cyclosporine. The primary end-point of these therapies is to avoid colectomy in patients with severe disease when intravenous steroids have failed. Cyclosporine has been successful for induction of remission in severe UC, but undesirable side effects present quickly after intravenous delivery. We report two cases with severe UC that were successfully treated with oral microemulsion form of cyclosporine.