Abstract:
Background/Objectives: The treatment of patients with mild-to-moderate ulcerative colitis (UC) is challenging. Although there are commonly used guidelines, therapy optimization is not standardized. We conducted a survey to investigate the management and treatment of patients with mild-to-moderate UC. Methods: Physicians with experience in treating inflammatory bowel diseases (IBD) were invited to participate in an anonymous, multiple-choice survey between June and July 2023. The survey addressed various issues of patient care such as patient monitoring, treatment optimization, follow-up, treatment decision making, and therapy de-escalation. Results: The survey included 222 physicians (59.9% men; mean age = 50.4 years) from 66 countries worldwide. Gastroenterologists were the most represented specialists (89.6%), followed by surgeons (3.2%), and internal medicine doctors (2.7%). Two-thirds of the participants (66.7%) had >10 years of experience in the field of IBD. The combination of oral (≥4 g/day) and rectal 5-aminosalicylic acid (5-ASA) was the preferred choice when optimizing therapy. Budesonide MMX (41.8%) and systemic steroids (39.9%) were preferred in patients who failed 5-ASA. Treatment decisions were predominantly based on endoscopic (99.0%) or clinical (59.8%) activity. A significant percentage of clinicians did not optimize therapy in the case of increased fecal calprotectin alone (45.1%) or radiological/ultrasound activity (39.8%) alone. Conclusions: The guidelines for the management of mild-to-moderate UC are well accepted in clinical practice. Endoscopic remission remains the main therapeutic target, followed by clinical remission. Fecal calprotectin and intestinal ultrasound still elicit complaints from physicians.
摘要:
背景/目标:轻度至中度溃疡性结肠炎(UC)患者的治疗具有挑战性。虽然有常用的指导方针,治疗优化不规范。我们进行了一项调查,以调查轻中度UC患者的管理和治疗。方法:邀请有治疗炎症性肠病(IBD)经验的医生参加匿名,2023年6月至7月的多项选择调查。该调查解决了患者护理的各种问题,例如患者监测,治疗优化,后续行动,治疗决策,和治疗降级。结果:调查包括来自全球66个国家的222名医生(59.9%的男性;平均年龄=50.4岁)。胃肠病学家是代表最多的专家(89.6%),其次是外科医生(3.2%),和内科医生(百分之二点七)。三分之二的参与者(66.7%)在IBD领域有>10年的经验。优化治疗时,口服(≥4g/天)和直肠5-氨基水杨酸(5-ASA)的组合是首选。布地奈德MMX(41.8%)和全身性类固醇(39.9%)在5-ASA失败的患者中是首选。治疗决定主要基于内窥镜(99.0%)或临床(59.8%)活性。在单独增加粪便钙卫蛋白(45.1%)或单独增加放射学/超声活动(39.8%)的情况下,相当比例的临床医生没有优化治疗。结论:轻中度UC的治疗指南在临床实践中被广泛接受。内镜缓解仍是主要的治疗靶点,其次是临床缓解。粪便钙卫蛋白和肠道超声仍然引起医生的抱怨。