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Ulcerative Colitis: Management in Adults, Children and Young People [Internet].

Editors

National Clinical Guideline Centre (UK).

Source

London: Royal College of Physicians (UK); 2013 Jun.
National Institute for Health and Clinical Excellence: Guidance .

Excerpt

Ulcerative colitis is the most common type of inflammatory disease of the bowel. It has an incidence in the UK of approximately 10 per 100,000 people annually,and a prevalence of approximately 240 per 100,000. This amounts to around 146,000 people in the UK with a diagnosis of ulcerative colitis. The cause of ulcerative colitis is unknown. It can develop at any age, but peak incidence is between the ages of 15 and 25 years, with a second, smaller peak between 55 and 65 years (although this second peak has not been universally demonstrated). The British Paediatric Surveillance Unit reported an incidence of ulcerative colitis in children aged younger than 16 years in the United Kingdom, of 1.4 per 100,000 with a greater proportion of Asian children having ulcerative colitis than other children. The median age for diagnosis of ulcerative colitis overall in this childhood cohort was 11.7 years (range 9.3 to 13.7 years). Care of people with ulcerative colitis is usually shared between primary care and specialist gastroenterology units working in collaboration with specialist colorectal surgical units. Close links are required to allow specialist input, rapid access to advice (especially when symptoms worsen) and coordinated monitoring of drug-side effects, and to ensure that associated issues (such as monitoring of bone density) are addressed. However, the number of adults with ulcerative colitis definitely under specialist care may not be as high as thought, and may be as low as 30%. The most appropriate setting for a person’s care is likely to come under increasing scrutiny as commissioning groups seek to provide more care in the community. This guideline therefore covers areas defined within the scope (Appendix A). Detailed delineation of areas excluded is given in the scope, but it should be noted that this guideline does not address areas of diagnosis, diagnostic investigation and surgical technique. Chapter 5 deals with induction of remission - the treatment of patients with active disease in relapse. This includes disease of limited extent (proctitis and proctosigmoiditis) and more extensive ulcerative colitis and includes treatment of acute severe colitis. In association with this, assessment of patients with acute severe colitis and their risk of requiring surgery or escalation of therapy are considered. Following this, drug treatment to maintain remission is examined and then considerations of information for people considering elective surgery, considerations of pregnancy in women with ulcerative colitis and bone health and growth and development in children.

Copyright © 2013, National Clinical Guideline Centre.

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