背景:自2013年第一版指南发布以来,关于溃疡性结肠炎的治疗已经产生了很多信息,并引入了新的药物和行动方案。临床实践发生了很大变化,保证采取新的方法,并对证据进行全面审查和更新。
方法:再次,我们使用了分级方法,由电子工具(https://gradepro.org)支持。临床情况与以前的版本相同(严重和轻度-中度发作的诱导和维持),变量及其评估也是如此。然而,在更新的指南中,删除了三个问题,增加了14个,保持了30个,共做44个临床问题。在详尽审查了证据之后,建议现已更新。
结果:在分析的44个问题中,由于证据质量很低,无法将建议一分为二,而在其他42个中,基于不同程度的证据质量,根据等级制度提出了建议。在其中25个问题中,最终建议强烈赞成,在六个强烈反对中,七个弱赞成,四个弱反对。根据情景和建议,提出了六种算法作为实际决策的简单指南。
结论:本次更新2013年指南的目的是提供答案,基于等级方法,对于不同的问题,我们每天都会问自己,在不同的临床情况下,为溃疡性结肠炎患者决定最合适的治疗方法。
BACKGROUND: Since the first edition of the
Guidelines was published in 2013, much information has been generated around the treatment of ulcerative colitis, and new drugs and action protocols have been introduced. Clinical practice has changed substantially, warranting new approaches and a comprehensive review and update of the evidence.
METHODS: Once again, we used the GRADE approach, supported by an electronic tool (https://gradepro.org). The clinical scenarios are the same as in the previous version (induction and maintenance in severe and mild-moderate flare-ups), as are the variables and their evaluation. However, in the updated
guidelines, three questions have been deleted, 14 added and 30 maintained, making a total of 44 clinical questions. After an exhaustive review of the evidence, the recommendations are now updated.
RESULTS: Of the 44 questions analysed, no recommendation could be established in two due to the very low quality of the evidence, while in the other 42, based on different degrees of quality of evidence, recommendations were made according to the GRADE system. In 25 of these questions the final recommendation is strongly in favour, in six strongly against, in seven weakly in favour and in four weakly against. According to the scenarios and recommendations, six algorithms are proposed as a simple guide for practical decision-making.
CONCLUSIONS: The aim of this update of the 2013
guidelines is to provide answers, based on the GRADE approach, to the different questions we ask ourselves daily when deciding the most appropriate treatment for our patients with ulcerative colitis in the different clinical scenarios.