Evidence base: Ulcerative colitis

Clinical trials

• Rutgeerts P, Sandborn WJ, Feagan BG et al. Infliximab for induction and maintenance therapy for ulcerative colitis. N Eng J Med 2005; 353 (23): 2462-76.

The ACT 1 and ACT 2 (Acute UC Treatment) trials evaluated the use of infliximab in UC. They showed a clinically significant response in patients treated with infliximab compared with those on placebo.

• Jakobovits SL, Jewell DP, Travis S. Infliximab for the treatment of UC: outcomes in Oxford from 2000 to 2006. Aliment Pharmacol Ther 2007; 25: 1055-60.

Just over half the patients treated with infliximab required colectomy at a median of 140 days after the first infusion. Of those avoiding colectomy, only 17 per cent sustained a steroid-free remission.

Guidelines

• The British Society of Gastroenterology recently published an update of the Guidelines for the management of inflammatory bowel disease in adults.⁵
• The British Society of Paediatric Gastroenterology, Hepatology and Nutrition12 published Guidelines for IBD management in children.
• NICE. Infliximab for acute exacerbations of ulcerative colitis. TA163, London, NICE, 2008.
• NICE. Infliximab for subacute manifestations of ulcerative colitis. TA140, London, NICE, 2008.
• NICE. Colonoscopic surveillance for prevention of colorectal cancer in people with ulcerative colitis, Crohn's disease or adenoma. CG118, London, NICE, 2011.

Key text

• Nicholls RJ, Tekkis PP. Ulcerative Colitis. In: Philips RKS. Colorectal surgery: A companion to specialist surgical practice (fourth edition). Elsevier Health Sciences.

Online

• A clear and comprehensive information sheet for patients and families. www.bsg.org.uk/patients/patients/general/ulcerative-colitis.html
• Crohn's and Colitis UK provide patient information sheets. www.nacc.org.uk/content/services/infoSheets.asp
• Patient-centred website on all aspects of UC with links to support groups for patients. www.ulcerativecolitis.org.uk

Contributed by Dr Kenneth Fung, F2 doctor, London deanery, and Mr Joseph Dawson, specialist registrar in general surgery, North East Thames deanery