SECOND BRAZILIAN CONSENSUS ON THE MANAGEMENT OF ULCERATIVE COLITIS IN ADULTS: A CONSENSUS OF THE BRAZILIAN ORGANIZATION FOR CROHN’S DISEASE AND COLITIS (GEDIIB)
Faculdade de Medicina de Botucatu, Júlio Pinheiro Baima, Marcello Imbrizi, Adriana Ribas Andrade, Liliana Andrade Chebli, Marjorie Argollo, Natália Sousa Freitas Queiroz, Matheus Freitas Cardoso de Azevedo, Andréa Vieira, Irmandade Santa Casa de Misericórdia de São Paulo, Márcia Henriques de Magalhães Costa, Renata de Sá Brito Fróes, Gastromed, São Paulo, SP, Francisco Guilherme Cancela e Penna, Abel Botelho Quaresma, Adérson Omar Mourão Cintra Damião, Antônio Carlos Moraes, Carlos Henrique Marques dos Santos, Cristina Flores, Centro de Referência em Crohn e Colite do Rio Grande do Sul, Cyrla Zaltman, Eduardo García Vilela, Eloá Marussi Morsoletto, Francisco de Assis Gonçalves Filho, Faculdade de Medicina de São José do Rio Preto, Genoile Oliveira Santana, Gilmara Pandolfo Zabot, José Miguel Luz Parente, Lígia Yukie Sassaki, Marco Zerôncio, Marta Brenner Machado, Ornella Sari Cassol, Paulo Gustavo Kotze, Rogério Serafim Parra, Faculdade de Medicina de Ribeirão Preto, Sender Jankiel Miszputen, Professor Aposentado da UNIFESP, Cláudio Saddy Rodrigues Coy, Orlando Ambrogini, Júlio Maria Fonseca Chebli, Rogério Saad-Hossne
Abstract
BACKGROUND: Inflammatory bowel diseases are immune-mediated disorders that include Crohn's disease (CD) and ulcerative colitis (UC). UC is a progressive disease that affects the colorectal mucosa causing debilitating symptoms leading to high morbidity and work disability. As a consequence of chronic colonic inflammation, UC is also associated with an increased risk of colorectal cancer. OBJECTIVE: This consensus aims to provide guidance on the most effective medical management of adult patients with UC. METHODS: A consensus statement was developed by stakeholders representing Brazilian gastroenterologists and colorectal surgeons (Brazilian Organization for Crohn's Disease and Colitis [GEDIIB]). A systematic review including the most recent evidence was conducted to support the recommendations and statements. All recommendations/statements were endorsed using a modified Delphi Panel by the stakeholders/experts in inflammatory bowel disease with at least 80% or greater consensus. RESULTS AND CONCLUSION: The medical recommendations (pharmacological and non-pharmacological) were mapped according to the stage of treatment and severity of the disease onto three domains: management and treatment (drug and surgical interventions), criteria for evaluating the effectiveness of medical treatment, and follow-up/patient monitoring after initial treatment. The consensus targeted general practitioners, gastroenterologists and surgeons who manage patients with UC, and supports decision-making processes by health insurance companies, regulatory agencies, health institutional leaders, and administrators.