Ulcerative colitis: management – NICE guideline

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This National Institute for Health and Care Excellence (NICE) guideline covers the care and treatment of adults, children and young people who have ulcerative colitis (UC). It aims to help professionals to provide consistent high-quality care and it highlights the importance of advice and support for people with ulcerative colitis.

Key recommendations

Patient information and support

Discuss the disease and associated symptoms, treatment options and monitoring:

  • with the person with ulcerative colitis, and their family members or carers as appropriate and
  • within the multidisciplinary team (the composition of which should be appropriate for the age of the person) at every opportunity.

Inducing remission: step 1 therapy for mild to moderate ulcerative colitis

  • To induce remission in people with a mild to moderate first presentation or inflammatory exacerbation of proctitis or proctosigmoiditis:
    • offer a topical aminosalicylate alone (suppository or enema, taking into account the person's preferences) or
    • consider adding an oral aminosalicylate to a topical aminosalicylate or
    • consider an oral aminosalicylate alone, taking into account the person's preferences and explaining that this is not as effective as a topical aminosalicylate alone or combined treatment.
  • To induce remission in adults with a mild to moderate first presentation or inflammatory exacerbation of left-sided or extensive ulcerative colitis:
    • offer a high induction dose of an oral aminosalicylate
    • consider adding a topical aminosalicylate or oral beclometasone dipropionate, taking into account the person's preferences.
  • To induce remission in children and young people with a mild to moderate first presentation or inflammatory exacerbation of left-sided or extensive ulcerative colitis:
    • offer an oral aminosalicylate
    • consider adding a topical aminosalicylate or oral beclometasone dipropionate, taking into account the person's preferences (and those of their parents or carers as appropriate).

Inducing remission: step 2 therapy for acute severe ulcerative colitis

  • Consider adding intravenous ciclosporin to intravenous corticosteroids or consider surgery for people:
    • who have little or no improvement within 72 hours of starting intravenous corticosteroids or
    • whose symptoms worsen at any time despite corticosteroid treatment.
  • Take into account the person's preferences when choosing treatment.

Monitoring treatment

  • Ensure that there are documented local safety monitoring policies and procedures (including audit) for adults, children and young people receiving treatment that needs monitoring:
    • aminosalicylates
    • tacrolimus
    • ciclosporin
    • infliximab
    • azathioprine
    • mercaptopurine.
  • Nominate a member of staff to act on abnormal results and communicate with GPs and people with ulcerative colitis (and/or their parents or carers as appropriate).

Assessing likelihood of needing surgery

  • Assess and document on admission, and then daily, the likelihood of needing surgery for people admitted to hospital with acute severe ulcerative colitis.

Information about treatment options for people who are considering surgery

  • For people with ulcerative colitis who are considering surgery, ensure that a specialist (such as a gastroenterologist or a nurse specialist) gives the person (and their family members or carers as appropriate) information about all available treatment options, and discusses this with them. Information should include the benefits and risks of the different treatments and the potential consequences of no treatment.
  • After surgery, ensure that a specialist who is knowledgeable about stomas (such as a stoma nurse or a colorectal surgeon) gives the person (and their family members or carers as appropriate) information about managing the effects on bowel function. This should be specific to the type of surgery performed (ileostomy or ileoanal pouch) and could include the following:
    • strategies to deal with the impact on their physical, psychological and social wellbeing
    • where to go for help if symptoms occur
    • sources of support and advice.

Maintaining remission

  • Consider a once-daily dosing regimen for oral aminosalicylates when used for maintaining remission. Take into account the person's preferences, and explain that once-daily dosing can be more effective, but may result in more side effects.

Ulcerative colitis is a lifelong disease that is associated with significant morbidity. It can also affect a person's social and psychological wellbeing, particularly if poorly controlled. Typically, it has a relapsing–remitting pattern.

The wide choice of drug preparations and dosing regimens, the judgement required in determining the optimum timing for surgery (both electively and as an emergency) and the importance of support and information may lead to variation in practice across the UK. This guideline aims to address this variation, and to help healthcare professionals to provide consistent high-quality care. Managing ulcerative colitis in adults and children overlaps in many regards, so the guideline incorporates advice that is applicable to children and young people, which again should help to address potential inconsistencies in practice.

You can read the guideline on NICE's website.