Treatment Essentials for Ulcerative Colitis in Adults (Part 2) 2022 PANCO Clinical Practice Guidelines Recommended at a Glance

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In July 2022, the Pan American Crohn's Disease and Colitis Organization (PANCCO) Update published guidelines
for the treatment of ulcerative colitis in adults.

Review: Points of treatment for ulcerative colitis in adults (Part 1)2022 List of recommended clinical practice guidelines for PANCCO

The recommended points of the second half of the drug treatment in the guidelines are summarized as follows:

Recommendation 21: Rectal 5-ASA maintenance remission
is recommended for patients with UC.

(Recommended level: conditional; Quality of the evidence: low)

Practice points: The topical dose of 5-ASA for maintenance of remission is 500 or 1000 mg, which is more convenient
than enemas.

Recommendation 22: Oral 5-ASA is recommended in patients with mild to moderate UC to maintain clinical and endoscopic remission
.

(Recommended level: strong; Quality of the evidence: moderate)

Recommendation 23: Oral mesalazine or sulfasalazine is recommended in patients with mild to moderate UC to maintain remission
.

(Recommended level: strong; Quality of the evidence: low)

Practice points: In patients with mild to moderate UC, no difference was found in the maintenance of remission with conventional or extended-release oral mesalazine at equivalent doses
.

Recommendation 24: Thiopurines are recommended to maintain remission
in corticosteroid-dependent or drug-resistant UC patients.

(Recommended level: conditional; Quality of the evidence: low)

Practice points: The recommended dose of azathioprine is 2.

Recommendation 25: Probiotics are not recommended to maintain remission
in patients with UC.

(Recommended level: strong; Quality of the evidence: very low)

Recommendation 26: Combination administration of probiotics with 5-ASA is not recommended to maintain remission
in patients with UC.

(Recommended level: strong; Quality of the evidence: very low)

Recommendation 27: Nutritional therapy is not recommended to maintain remission
in patients with UC.

(Recommended level: conditional; Quality of the evidence: very low)

Practice points: Patients with UC should receive nutritional guidance
with accompanying drug therapy.

Recommendation 28: Curcumin monotherapy is not recommended to maintain remission
in patients with UC.

(Recommended level: conditional; Quality of the evidence: very low)

Recommendation 29: For patients with moderate to severe UC, biotherapy with anti-TNF-α agents (infliximab, adalimumab, and golimumumab), anti-integrin alfa 4β7 (videlizumab), or IL-12/23 inhibitors (uscinumab) is recommended to maintain remission
.
(Recommended level: strong; Quality of the evidence: low)

Recommendation 30: For patients with moderate to severe UC, tofatinib (JAK inhibitor) is recommended to maintain remission
.

(Recommended level: strong; Quality of the evidence: low)

Recommendation 31: Remission
in patients with ciprofloxacin-induced pouchitis is recommended.

(Recommended level: conditional; Quality of the evidence: very low)

Recommendation 32: When ciprofloxacin cannot be given, metronidazole is recommended to induce remission
in patients with acute pouchitis.

(Recommended level: conditional; Quality of the evidence: very low)

Recommendation 33: In patients with chronic pouchitis who do not respond to conventional therapy, it is recommended to induce and maintain remission
with an anti-TNF preparation (infliximab or adalimumab).

(Recommended level: conditional; Quality of the evidence: very low)

Recommendation 34: In patients with chronic pouchitis who are refractory to conventional treatment (infliximab or adalimumab), the use of videlizumab is recommended to induce and maintain remission
.

(Recommended level: conditional; Quality of the evidence: very low)

References: Juliao-Baños F, Grillo-Ardila C F, Alfaro I, et al.
Update of the PANCCO clinical practice guidelines for the treatment of ulcerative colitis in the adult population[J].
Revista de Gastroenterología de México (English Edition), 2022.