2013 NICE CG166 儿童、青少年、成人溃疡性结肠炎的管理
Ulcerative colitis Management in adults, children and young people
2013-06-26
Ulcerative colitis is the most common type of inflammatory disease of the bowel. It has anincidence in the UK of approximately 10 per 100,000 people annually, and a prevalence ofapproximately 240 per 100,000. This amounts to around 146,000 people in the UK with adiagnosis of ulcerative colitis. The cause of ulcerative colitis is unknown. It can develop at anyage, but peak incidence is between the ages of 15 and 25 years, with a second, smaller peakbetween 55 and 65 years (although this second peak has not been universally demonstrated).Ulcerative colitis usually affects the rectum, and a variable extent of the colon proximal to therectum. The inflammation is continuous in extent. Inflammation of the rectum is referred to asproctitis, and inflammation of the rectum and sigmoid as proctosigmoiditis. Left-sided colitisrefers to disease involving the colon distal to the splenic flexure. Extensive colitis affects thecolon proximal to the splenic flexure, and includes pan-colitis, where the whole colon is involved.Symptoms of active disease or relapse include bloody diarrhoea, an urgent need to defaecateand abdominal pain.Ulcerative colitis is a lifelong disease that is associated with significant morbidity. It can alsoaffect a person's social and psychological wellbeing, particularly if poorly controlled. Typically, ithas a relapsing–remitting pattern.Current medical approaches focus on treating active disease to address symptoms, to improvequality of life, and thereafter to maintain remission. The long-term benefits of achieving mucosalhealing remain unclear. The treatment chosen for active disease is likely to depend on clinicalseverity, extent of disease and the person's preference, and may include the use ofaminosalicylates, corticosteroids or biological drugs. These drugs can be oral or topical (into therectum), and corticosteroids may be administered intravenously in people with acute severedisease. Surgery may be considered as emergency treatment for severe ulcerative colitis thatdoes not respond to drug treatment. People may also choose to have elective surgery forunresponsive or frequently relapsing disease that is affecting their quality of life.Advice and support for people with ulcerative colitis is important, in terms of discussing theeffects of the condition and its course, medical treatment options, the effects of medication andthe monitoring required. Around 10% of inpatients with inflammatory bowel disease reported alack of information about drug side effects on discharge from hospital. Information to supportdecisions about surgery is also essential, both for clinicians and for people facing the possibilityof surgery. This includes recognising adverse prognostic factors for people admitted with acutesevere colitis to enable timely decisions about escalating medical therapy or predicting the needfor surgery. It is also very important to provide relevant information to support people consideringelective surgery.The wide choice of drug preparations and dosing regimens, the judgement required indetermining the optimum timing for surgery (both electively and as an emergency) and theimportance of support and information may lead to variation in practice across the UK. Thisguideline aims to address this variation, and to help healthcare professionals to provideconsistent high-quality care. Managing ulcerative colitis in adults and children overlaps in manyregards, so the guideline incorporates advice that is applicable to children and young people,which again should help to address potential inconsistencies in practice.
