Guía para el manejo de colitis ulcerativa en población adulta (actualización)
DOI:
https://doi.org/10.22516/25007440.636Palabras clave:
Colitis ulcerativa, actividad, cicatrización mucosa, terapia biológica, vigilancia endoscópica, cromoendoscopiaResumen
Objetivo: desde 2015, la Asociación Colombiana de Gastroenterología, con el apoyo del Instituto de Investigaciones Clínicas de la Universidad Nacional de Colombia, realizó la guía de práctica clínica para el diagnóstico y tratamiento de colitis ulcerativa. Desde la publicación de esta guía, han aparecido nuevas alternativas terapéuticas y nuevos conceptos sobre los objetivos del tratamiento, por lo cual se consideró necesaria su actualización.
Materiales y métodos: esta actualización fue realizada por un equipo multidisciplinario con apoyo de la Asociación Colombiana de Gastroenterología y el Instituto de Investigaciones Clínicas de la Universidad Nacional de Colombia. Se desarrollaron preguntas relevantes a nuevos tratamientos y vigilancia endoscópica de los pacientes adultos con colitis ulcerativa y se realizó la búsqueda de guías nacionales e internacionales en bases de datos especializadas. Las guías fueron evaluadas en términos de calidad y aplicabilidad. El Grupo Cochrane llevó a cabo la búsqueda sistemática de la literatura. Las tablas de evidencia y recomendaciones fueron realizadas usando la metodología GRADE.
Resultados: se realizó una actualización de la guía para el tratamiento de la colitis ulcerativa en adultos en Colombia y se diseñaron nuevos algoritmos de tratamiento, teniendo en cuenta la extensión y la actividad de la enfermedad y los diferentes niveles de atención.
Conclusiones: se estableció la importancia para el tratamiento de la evaluación clínica y endoscópica y se especificaron las indicaciones para el adecuado tratamiento de los pacientes con colitis ulcerativa. Adicionalmente, se dieron recomendaciones de vigilancia endoscópica de cáncer colorrectal y la importancia de la cromoendoscopia.
Descargas
Referencias bibliográficas
Ungaro R, Mehandru S, Allen PB, et al. Ulcerative Colitis. Lancet. 2017;389(10080):1756-1770.
https://doi.org/10.1016/S0140-6736(16)32126-2
Magro F, Gionchetti P, Eliakim R, et al. Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-intestinal Manifestations, Pregnancy, Cancer Surveillance, Surgery, and Ileo-anal Pouch Disorders. J Crohns Colitis. 2017 jun;11(6):649-670.
https://doi.org/10.1093/ecco-jcc/jjx008
Kaplan GG, Ng SC. Understanding and preventing the global increase of inflammatory bowel disease. Gastroenterology. 2017;152(2):313-321.
https://doi.org/10.1053/j.gastro.2016.10.020
Loftus Jr EV, Sandborn WJ. Epidemiology of inflammatory bowel disease. Gastroenterol Clin N Am 2002;31: 1-20.
https://doi.org/10.1016/S0889-8553(01)00002-4
Ng SC, Shi HY, Hamidi N, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet. 2017;390(10114):2769-2778.
https://doi.org/10.1016/S0140-6736(17)32448-0
Juliao-Baños F, Damas OM, Arrubla M, et al. The Prevalence of Inflammatory Bowel Disease in Colombia is Increasing: Report on the National Prevalence of IBD and Description of IBD Phenotype. Gastroenterology 2019 May, Vol. 156, Issue 6, S-405.
https://doi.org/10.1016/S0016-5085(19)37865-5
Ordas I, Eckmann L, Talamini M, Baumgart D, Sandborn WJ. Ulcerative Colitis. Lancet. 2012;380(9853):1606-19.
https://doi.org/10.1016/S0140-6736(12)60150-0
Beaugerie L, Massot N, Carbonnel F, Cattan S, Gendre JP, Cosnes J. Impact of cessation of smoking on the course of ulcerative colitis. Am J Gastroenterol. 2001; 96:2113-16.
https://doi.org/10.1111/j.1572-0241.2001.03944.x
Koutroubakis IE, Vlachonikolis IG. Appendectomy and the development of ulcerative colitis: Results of a metaanalysis of published case-control studies. Am J Gastroenterol. 2000; 95:171-76.
https://doi.org/10.1111/j.1572-0241.2000.01680.x
Sonnenberg A, Genta RM. Low prevalence of Helicobacter pylori infection among patients with inflammatory bowel disease. Aliment Pharmacol Ther 2012; 35:469-76.
https://doi.org/10.1111/j.1365-2036.2011.04969.x
Lönnfors S, Vermeire S, Greco M, et al. IBD and health related quality of life Discovering the true impact. J Crohn's Colitis. 2014;8,1281-1286.
https://doi.org/10.1016/j.crohns.2014.03.005
Juliao F, Ruiz M, Florez JF, et al. Fenotipo e historia natural de la enfermedad inflamatoria intestinal en un centro de referencia en Medellín-Colombia. Rev Col Gastro 2010;23(3):240-251.
Maaser C, Sturm A, Vavricka SR, et al. ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1: Initial diagnosis, monitoring of known IBD, detection of complications. J Crohns Colitis. 2019;13(2):144-164.
https://doi.org/10.1093/ecco-jcc/jjy113
Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a working party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol 2005;19(Suppl A):5-36.
https://doi.org/10.1155/2005/269076
Truelove SC, Witts LJ. Cortisone in ulcerative colitis: final report on a therapeutic trial. Br Med J 1955; 2:1041-8.
https://doi.org/10.1136/bmj.2.4947.1041
Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, Long MD. ACG Clinical Guideline: Ulcerative Colitis in Adults. Am J Gastroenterol. 2019 Mar;114(3):384-413.
https://doi.org/10.14309/ajg.0000000000000152
Rioux K. What is the prognosis of ulcerative colitis? Inflamm Bowel disease. 2008; Oct;14 Suppl 2: S52-3.
https://doi.org/10.1002/ibd.20574
Roda G, Narula N, Pinotti R, et al. Systematic review with meta-analysis: proximal disease extension in limited ulcerative colitis. Aliment Pharmacol Ther. 2017; 45:1481-1492.
https://doi.org/10.1111/apt.14063
Frolkis AD, Dykeman J, Negrón ME, et al. Risk of Surgery for Inflammatory Bowel Diseases Has Decreased Over Time: A Systematic Review and Meta-analysis of Population-Based Studies. Gastroenterology 2013; 145:996-1006.
https://doi.org/10.1053/j.gastro.2013.07.041
Singh S, Feuerstein JD, Binion DG, Tremaine WJ. AGA Technical Review on the Management of Mild-to-Moderate Ulcerative Colitis. Gastroenterology. 2019;156(3):769-808.
https://doi.org/10.1053/j.gastro.2018.12.008
Singh S, Allegretti JR, Siddique SM, Terdiman JP. AGA Technical Review on the Management of Moderate to Severe Ulcerative Colitis. Gastroenterology. 2020;158(5):1465-1496.
https://doi.org/10.1053/j.gastro.2020.01.007
PAHO. Directriz para el fortalecimiento de los programas nacionales de guías informadas por la evidencia. Una herramienta para la adaptación e implementación de guías en las américas. Washington, D.C.: OPS; 2018. Disponible en: http://iris.paho.org/xmlui/handle/123456789/49145
Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, Norris S, Falck-Ytter Y, Glasziou P, DeBeer H, Jaeschke R, Rind D, Meerpohl J, Dahm P, Schünemann HJ. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011 Apr;64(4):383-94.
https://doi.org/10.1016/j.jclinepi.2010.04.026
Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, Moher D, Tugwell P, Welch V, Kristjansson E, Henry DA. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017 Sep 21;358: j4008
https://doi.org/10.1136/bmj.j4008
Higgins JPT, Deeks JJ, Davenport C, Clarke MJ. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.2.0 (updated February 2017), Cochrane, 2017. Available from Cochrane Community.
Bewtra M, Johnsson R. Assessing Patient Preferences for Treatment Options and Process of Care in Inflammatory Bowel Disease: A Critical Review of Quantitative Data. Patient. 2013 Dec; 6(4): 10.1007/s40271-013-0031-2.
https://doi.org/10.1007/s40271-013-0031-2
Shah SC, Colombel JF, Sands BE, Narula N. Mucosal Healing Is Associated with Improved Long-term Outcomes of Patients with Ulcerative Colitis: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2016;14(9):1245-1255.
https://doi.org/10.1016/j.cgh.2016.01.015
National Clinical Guideline Centre (UK). Ulcerative Colitis: Management in Adults, Children and Young People [Internet]. London: Royal College of Physicians (UK); 2013 Jun. Available from http://www.ncbi.nlm.nih.gov/books/NBK247597/PubMed
Marshall JK, Thabane M, Steinhart AH, Newman JR, Anand A, Irvine EJ. Rectal 5-aminosalicylic acid for induction of remission in ulcerative colitis. Cochrane Database of Systematic Reviews. 2010; Issue 1:CD004115. CD004115. pub2.
https://doi.org/10.1002/14651858
Ford AC, Khan KJ, Achkar JP, Moayyedi P. Efficacy of Oral vs.Topical, or Combined Oral and Topical 5-Aminosalicylates, in Ulcerative Colitis: Systematic Review and Meta-Analysis Am J Gastroenterol 2012; 107:167-176
https://doi.org/10.1038/ajg.2011.410
Wang Y, Parker CE, Bhanji T, Feagan BG, MacDonald JK. Oral 5-aminosalicylic acid for induction of remission in ulcerative colitis. Cochrane Database Syst Rev. 2016 Apr 21;4:CD000543.
https://doi.org/10.1002/14651858.CD000543.pub4
Ford, A. Glucocorticosteroid Therapy in Inflammatory Bowel Disease: Systematic Review and Meta-Analysis. Am J Gastroenterol advance online publication, 15 March 2011.
Sherlock ME, MacDonald JK, Griffiths AM, Steinhart AH, Seow CH. Oral budesonide for induction of remission in ulcerative colitis. Cochrane Database Syst Rev. 2015 Oct 26;(10):CD007698.
https://doi.org/10.1002/14651858.CD007698.pub3
Timmer A, Patton PH, Chande N, McDonald JW, MacDonald JK. Azathioprine and 6-mercaptopurine for maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev. 2016 May 18;(5):CD000478.
https://doi.org/10.1002/14651858.CD000478.pub4
Astó E, Méndez I, Audivert S, Farran-Codina A, Espadaler J. The Efficacy of Probiotics, Prebiotic Inulin-Type Fructans, and Synbiotics in Human Ulcerative Colitis: A Systematic Review and Meta-Analysis. Nutrients. 2019 Jan 30;11(2). pii: E293.
https://doi.org/10.3390/nu11020293
Bonovas S, Lytras T, Nikolopoulos G, Peyrin-Biroulet L, Danese S. Systematic review with network meta-analysis: comparative assessment of tofacitinib and biological therapies for moderate-to-severe ulcerative colitis. Aliment Pharmacol Ther. 2018 Feb;47(4):454-465.
https://doi.org/10.1111/apt.14449
Paschos P, Katsoula A, Giouleme O, Sarigianni M, Liakos A, Athanasiadou E, Bekiari E, Tsapas A. Tofacitinib for induction of remission in ulcerative colitis: systematic review and meta-analysis. Ann Gastroenterol. 2018 Sep-Oct;31(5):572-582
Grammatikopoulou MG, Gkiouras K, Theodoridis X, Asteriou E, Forbes A, Bogdanos DP. Oral Adjuvant Curcumin Therapy for Attaining Clinical Remission in Ulcerative Colitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients. 2018 Nov 12;10(11). pii: E1737
https://doi.org/10.3390/nu10111737
Kafil TS, Nguyen TM, MacDonald JK, Chande N. Cannabis for the treatment of ulcerative colitis. Cochrane Database Syst Rev. 2018 Nov 8;11:CD012954.
https://doi.org/10.1002/14651858.CD012954
Narula N, Kassam Z, Yuan Y, Colombel JF, Ponsioen C, Reinisch W, Moayyedi P. Systematic Review and Meta-analysis: Fecal Microbiota Transplantation for Treatment of Active Ulcerative Colitis. Inflamm Bowel Dis. 2017;23(10):1702-1709.
https://doi.org/10.1097/MIB.0000000000001228
Vickers AD, et al. Systematic Review with Network Meta-Analysis: Comparative Efficacy of Biologics in the Treatment of Moderately to Severely Active Ulcerative Colitis. PLoS ONE 2016; 11(10): e0165435.
https://doi.org/10.1371/journal.pone.0165435
Trigos-Vicente C et al. Systematic review and network meta‑analysis of treatment for moderate‑to‑severe ulcerative colitis. International Journal of Clinical Pharmacy 2018;
https://doi.org/10.1007/s11096-018-0743-4
Sands BE, Peyrin-Biroulet L, Loftus EV Jr, Danese S, Colombel J-F, Törüneret M et al. Vedolizumab versus Adalimumab for Moderate-to-Severe Ulcerative Colitis. N Engl J Med. 2019;381(13):1215-1226.
https://doi.org/10.1056/NEJMoa1905725
Komaki Y, et al. Systematic review with meta-analysis: the efficacy and safety of CT-P13, a biosimilar of anti-tumor necrosis factor- agent (infliximab), in inflammatory bowel diseases. Aliment Pharmacol Ther 2017; 45: 1043-1057.
https://doi.org/10.1111/apt.13990
https://doi.org/10.1111/apt.14060
Sands BE, Sandborn WJ, Panaccione R, O'Brien Ch, Zhang H, Johanns J, et al. Ustekinumab as Induction and Maintenance Therapy for Ulcerative Colitis. N Engl J Med. 2019;381(13):1201-1214.
https://doi.org/10.1056/NEJMoa1900750
Mocko P, et al. Safety profile of biologic drugs in the therapy of ulcerative colitis: a systematic review and network meta-analysis. Alimentary Pharmacology & Therapeutics 2017 45 (8);870-79
https://doi.org/10.1002/phar.1785
Paschos P, et al. Systematic review with network meta‐analysis: the impact of medical interventions for moderate‐to‐severe ulcerative colitis on health‐related quality of life. Aliment Pharmacol Ther. 2018; 48:1174-1185
https://doi.org/10.1111/apt.15005
Singh S, Murad MH, Fumery M, Dulai PS, Sandborn WJ. First- and Second-Line Pharmacotherapies for Patients with Moderate to Severely Active Ulcerative Colitis: An Updated Network Meta-Analysis [published online ahead of print, 2020 Jan 13]. Clin Gastroenterol Hepatol. 2020; S1542-3565(20)30044-6. doi: 10.1016/j.cgh.2020.01.008
https://doi.org/10.1016/j.cgh.2020.01.008
Bye WA, Nguyen TM, Parker CE, Jairath V, East JE. Strategies for detecting colon cancer in patients with inflammatory bowel disease. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD000279. DOI: 10.1002/14651858.CD000279.pub4
https://doi.org/10.1002/14651858.CD000279.pub4
Bessissow T, Dulai PS, Restellini S, Landry T, Bisschops R, Murad MH, Singh S. Comparison of Endoscopic Dysplasia Detection Techniques in Patients with Ulcerative Colitis: A Systematic Review and Network Meta-analysis. Inflamm Bowel Dis. 2018 Nov 29;24(12):2518-2526.
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Aquellos autores/as que tengan publicaciones con esta revista, aceptan los términos siguientes:
Los autores/as ceden sus derechos de autor y garantizarán a la revista el derecho de primera publicación de su obra, el cuál estará simultáneamente sujeto a la Licencia de reconocimiento de Creative Commons que permite a terceros compartir la obra siempre que se indique su autor y su primera publicación en esta revista.
Los contenidos están protegidos bajo una licencia de Creative Commons Reconocimiento-NoComercial-SinObraDerivada 4.0 Internacional.

Estadísticas de artículo | |
---|---|
Vistas de resúmenes | |
Vistas de PDF | |
Descargas de PDF | |
Vistas de HTML | |
Otras vistas |