Medical management of left-sided ulcerative colitis and ulcerative proctitis: critical evaluation of therapeutic trials.
BACKGROUND
The goal of this work was to critically evaluate the published studies on the treatment of ulcerative proctitis (UP) and left-sided ulcerative colitis (L-UC). The results of this review provided the content for the accompanying treatment guidelines, Clinical Guidelines for the Medical Management of Left-sided Ulcerative Colitis and Ulcerative Proctitis: Summary Statement.


METHODS
All English language articles published between 1995 and September 2005 were identified through a comprehensive literature search using OVID and PubMed. The quality of the data supporting or rejecting the use of specific therapies was categorized by a data quality grading scale. An "A+" grade was assigned to treatment supported by multiple high-quality randomized controlled trials with consistent results, whereas a "D" grade was given to therapy supported only by expert opinion. The therapeutic efficacy of a treatment was defined by its success in treating UP and L-UC compared with placebo. A medication was ranked as "excellent" if it was specifically studied for UP and L-UC and had consistently positive results compared with placebo or another agent. Quality and efficacy scores were agreed on by author consensus.


RESULTS
For the acute treatment of UP or L-UC, the rectally administered corticosteroids and mesalazine (5-ASA), either alone or in combination with oral 5-ASAs, are the most effective therapy: evidence quality, A+; efficacy, excellent. Only rectally administered 5-ASA received an A+/excellent rating for maintenance of remission. Infliximab received an A+ grade for induction and maintenance of remission but only a "good" rating because the studies were performed in all UC, not specifically UP or L-UC.


CONCLUSIONS
This critical evaluation of treatment provides a "report card" on medications available for the management of patients with UP and L-UC. The guidelines should provide a useful reference and supplement for physicians treating UC patients.
Regueiro
Miguel
M
Inflammatory Bowel Disease Center and Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA. mdr7@pitt.edu
Loftus
Edward V
EV
Steinhart
A Hillary
AH
Cohen
Russell D
RD
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D000906:Antibodies / Q000627:therapeutic use; D002986:Clinical Trials as Topic / Q000379:methods; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D004333:Drug Administration Routes; D004359:Drug Therapy, Combination; D004926:Escherichia coli; D005232:Fatty Acids, Volatile / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D019804:Mesalamine / Q000008:administration & dosage; D009538:Nicotine / Q000627:therapeutic use; D019936:Probiotics / Q000627:therapeutic use; D011349:Proctitis / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D012074:Remission Induction / Q000379:methods; D012107:Research Design; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000906:Antibodies; D005232:Fatty Acids, Volatile; D007155:Immunologic Factors; D019804:Mesalamine; D009538:Nicotine; D006493:Heparin