Management of ulcerative colitis: summary of updated NICE guidance

Ulcerative colitis is a chronic inflammatory disease of the rectum and colon characterised by mucosal inflammation, resulting in symptoms of diarrhoea (both soft stool and an increased frequency of defecation), rectal bleeding, an urgent need to defecate, and abdominal pain.

The condition usually affects the rectum and a variable extent of the colon proximal to the rectum. Inflammation of the rectum is referred to as proctitis, and inflammation of the rectum and sigmoid as proctosigmoiditis. Left sided colitis refers to disease involving the colon distal to the splenic flexure. Extensive colitis affects the colon proximal to the splenic flexure, and includes pan-colitis, where the whole colon is involved.

The most widely used drugs for inducing remission in people with mild to moderate ulcerative colitis are aminosalicylates and corticosteroids. Choice of treatment depends on the extent of disease (proctitis, proctosigmoiditis, left sided colitis, extensive colitis), mechanism of action, route of administration, site and mechanism of drug release, dose, duration, cost of treatment, and patient preference.

This article summarises recent recommendations from the update of the National Institute for Health and Care Excellence (NICE) guideline for the management of ulcerative colitis in children, young people, and adults.1 The update focuses on inducing remission in people with mild to moderate ulcerative colitis. All other areas of the guideline, such …