期刊
AMERICAN JOURNAL OF GASTROENTEROLOGY
卷 107, 期 2, 页码 179-194出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1038/ajg.2011.386
关键词
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资金
- Canadian Institutes of Health Research Institute of Nutrition, Metabolism, and Diabetes
- Abbott Canada (Montreal, Canada)
- Aptalis Pharma (Mont Saint-Hilaire, Canada)
- Janssen Inc. (Toronto, Canada)
- Shire Canada (Ville Saint-Laurent, Canada)
- UCB Pharma Canada (Oakville, Canada)
- Warner Chilcott (Toronto, Canada)
- Abbott
- Alba
- Albiero Pharma
- Aptalis
- Berlex
- Bristol-Myers Squibb
- Celgene
- Centocor
- Cerimon Pharma
- CombinatoRx
- Elan/Biogen
- Ferring
- GlaxoSmithKline
- GeneLogic Inc/Ore Pharma
- Genetech
- Genzyme
- Given Imaging
- ISIS
- Janssen-Ortho
- Millennium Research Group
- Napo Pharma
- Novartis
- Novo Nordisk
- Osiris Therapeutics
- Proctor & Gamble/Warner Chilcott
- Protein Design Labs
- Santarus
- Salax
- Shire
- Janssen
- Serono
- Synta
- Teva
- Tioga Pharma
- Tillotts
- UCB Pharma
- Unity Pharma
- Vertex
- VSL3
- Axcan
- ActoGenix
- Asahi Medical
- AstraZeneca
- Boehringer Engelheim
- Chemocentryx
- Nycomed
- Olympus America
- Otsuka
- Tillots
OBJECTIVES: The objective of this study was to provide updated explicit and relevant consensus statements for clinicians to refer to when managing hospitalized adult patients with acute severe ulcerative colitis (UC). METHODS: The Canadian Association of Gastroenterology consensus group of 23 voting participants developed a series of recommendation statements that addressed pertinent clinical questions. An iterative voting and feedback process was used to do this in conjunction with systematic literature reviews. These statements were brought to a formal consensus meeting held in Toronto, Ontario (March 2010), when each statement was discussed, reformulated, voted upon, and subsequently revised until group consensus (at least 80% agreement) was obtained. The modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria were used to rate the strength of recommendations and the quality of evidence. RESULTS: As a result of the iterative process, consensus was reached on 21 statements addressing four themes (General considerations and nutritional issues, Steroid use and predictors of steroid failure, Cyclosporine and infliximab, and Surgical issues). CONCLUSIONS: Key recommendations for the treatment of hospitalized patients with severe UC include early escalation to second-line medical therapy with either infliximab or cyclosporine in individuals in whom parenteral steroids have failed after 72 h. These agents should be used in experienced centers where appropriate support is available. Sequential therapy with cyclosporine and infliximab is not recommended. Surgery is an option when first-line steroid therapy fails, and is indicated when second-line medical therapy fails and/or when complications arise during the hospitalization.
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