Treatment of Mildly to Moderately Active Left-Sided Ulcerative Colitis
This protocol covers management of mildly to moderately active ulcerative colitis with left-sided distribution, guiding therapy selection for induction of remission based on current evidence.
The patient has mildly to moderately active ulcerative colitis with left-sided involvement. The priority is selecting a targeted induction strategy consistent with guideline recommendations for this specific disease extent and activity level.
Rectal 5-ASA therapy — preferred over rectal steroids — is the recommended first-line approach for induction of remission in this setting. The full protocol details the complete regimen.
Response to induction therapy is assessed within 8 weeks. Remission requires absence of rectal bleeding, no bowel urgency, normalised stool frequency, and a Mayo endoscopic score of 0 or 1.
References
DOI: 10.14309/ajg.0000000000003463
- In patients with mildly to moderately active left-sided UC, we suggest rectal 5-ASA enemas at a dose of at least 1 g/daily combined with oral 5-ASA at a dose of at least 2.0 g/daily compared with oral 5-ASA therapy alone for induction of remission
- In patients with mildly to moderately active proctitis or left sided colitis, we recommend rectal 5-ASA enemas at a dose of at least 1 g/daily preferred over rectal steroids for induction of remission
- Patients with mildly to moderately active UC should be reassessed to determine response to induction therapy within 8 weeks.
- In clinical trials, the definition of clinical remission has been a MES of 0 or 1, stool frequency of ≤1, and absence of rectal bleeding.