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Medical therapy of ulcerative colitis: updated guidelines of the Working group for IBD


Authors: M. Bortlík 1-4;  D. Ďuricová 5;  O. Hradský 6;  M. Lukáš 5;  (a členové Pracovní skupiny pro IBD ČGS ČLS JEP)
Authors place of work: Gastroenterologické oddělení, Nemocnice České Budějovice, a. s. 1;  Interní klinika 1. LF UK a ÚVN Praha 2;  Ústav farmakologie, 1. LF UK, Praha 3;  Zdravotně sociální fakulta, Jihočeská univerzita v Českých Budějovicích 4;  Klinické a výzkumné centrum pro střevní záněty, ISCARE a. s. a 1. LF UK, Praha 5;  2. lékařská fakulta, Univerzita Karlova, Praha 6
Published in the journal: Gastroent Hepatol 2026; 80(1): 14-21
Category: IBD: guidelines
doi: https://doi.org/10.48095/ccgh202614


Zdroje

1. Bortlík M, Ďuricová D, Hrdlička L et al. Doporučení Pracovní skupiny pro idiopatické střevní záněty pro diagnostiku a medikamentózní léčbu ulcerózní kolitidy. Gastroent Hepatol 2022; 76 (1): 13–28. doi: 10.48095/ccgh202213.

2. Turner D, Ricciuto A, Lewis A et al. STRIDE-II: An Update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) Initiative of the International Organization for the Study of IBD (IOIBD): Determining Therapeutic Goals for Treat-to-Target strategies in IBD. Gastroenterology 2021; 160 : 1570–1583. doi: 10.1053/j.gastro.2020.12.031.

3. Doherty G, Katsanos KH, Burisch J et al. European Crohn‘s and Colitis Organisation Topical Review on Treatment Withdrawal [‚Exit Strategies‘] in Inflammatory Bowel Disease. J Crohns Colitis 2018; 12 (1): 17–31. doi: 10.1093/ecco-jcc/ jjx101.

4. Dulai PS, Battat R, Barsky M et al. Incorporating Fecal Calprotectin Into Clinical Practice for Patients With Moderate-to-Severely Active Ulcerative Colitis Treated With Biologics or Small-Molecule Inhibitors. Am J Gastroenterol 2020; 115 (6): 885–894. doi: 10.14309/ajg.0000000000000596.

5. Wetwittayakhlang P, Lontai L, Gonczi L et al. Treatment Targets in Ulcerative Colitis: Is It Time for All In, including Histology? J Clin Med 2021; 10 (23): 5551. doi: 10.3390/jcm10235551.

6. Andus T, Kocjan A, Müser M et al. Clinical trial: a novel high-dose 1 g mesalamine suppository (Salofalk) once daily is as efficacious as a 500mg suppository thrice daily in active ulcerative proctitis. Inflam Bowel Dis 2010; 16 (11): 1947–1956. doi: 10.1002/ibd.21258.

7. Lamet M. A multicenter, randomized study to evaluate the efficacy and safety of mesalamine suppositories 1 g at bedtime and 500 mg twice daily in patients with active mild-to-moderate ulcerative proctitis. Dig Dis Sci 2011; 56 (2): 513–522. doi: 10.1007/s10620-010-1334-y.

8. Gionchetti P, Rizzello F, Venturi A et al. Comparison of oral with rectal mesalazine in the treatment of ulcerative proctitis. Dis Colon Rectum1998; 41 (1): 93–97. doi: 10.1007/BF022 36902.

9. Ng SC. Management of ulcerative colitis. In: Hart AL, Ng SC (eds). Inflammatory bowel disease: an evidence-based practical guide. Malta: Gutenberg Press Ltd 2012 : 5–12.

10. Marshall JK, Irvine EJ. Rectal corticosteroids versus alternative treatments in ulcerative colitis: a meta-analysis. Gut 1997; 40 (6): 775–781. doi: 10.1136/gut.40.6.775.

11. Lemmens P, Louis E, Van Moerkercke W et al. Outcome of Biological Therapies and Small Molecules in Ulcerative Proctitis: A Belgian Multicenter Cohort Study. Clin Gastroenterol Hepatol 2024; 22 (1): 154.e3–163.e3. doi: 10.1016/j.cgh.2023.06.023.

12. Peyrin-Biroulet L, Dubinsky MC, Sands BE et al. Efficacy and Safety of Etrasimod in Patients with Moderately to Severely Active Isolated Proctitis: Results From the Phase 3 ELEVATE UC Clinical Programme. J Crohns Colitis 2024; 18 (8): 1270–1282. doi: 10.1093/ecco-jcc/ jjae038.

13. Ford AC, Khan KJ, Achkar JP et al. Efficacy of oral vs. topical, or combined oral and topical 5-aminosalicylates, in Ulcerative Colitis: systematic review and meta-analysis. The Am J Gastroenterol 2012; 107 (2): 167–177. doi: 10.1038/ajg.2011.410.

14. Feagan BG, MacDonald JK. Once daily oral mesalamine compared to conventional dosing for induction and maintenance of remission in ulcerative colitis: a systematic review and meta-analysis. Inflamm Bowel Dis 2012; 18 (9): 1785–1794. doi: 10.1002/ibd.23024.

15. Murray A, Nguyen TM, Parker CE et al. Oral 5-aminosalicylic acid for induction of remission in ulcerative colitis. Cochrane Database Syst Rev 2020. doi: 10.1002/14651858.CD000543.

16. Ford AC, Achkar J-P, Khan KJ et al. Efficacy of 5-aminosalicylates in ulcerative colitis: systematic review and meta-analysis. Am J Gastroenterol 2011; 106 (4): 601–616. doi: 10.1038/ajg. 2011.67.

17. Raine T, Bonovas S, Burisch J et al. ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment. J Crohns Colitis 2022; 16 (1): 2–17. doi: 10.1093/ecco-jcc/jjab178.

18. Sands B, Peyrin.Biroulet L, Loftus EV et al. Vedolizumab versus Adalimumab for Moderate-to-Severe Ulcerative Colitis. N Engl J Med 2019; 381 (13): 1215–1226. doi: 10.1056/NEJMoa1905725.

19. Shebab M, Alrashed F, Alsayegh A et al. Comparative Efficacy of Biologics and Small Molecule in Ulcerative Colitis: A Systematic Review and Network Meta-analysis. Clin Gastroent Hepatol 2025; 23 (2): 250–262. doi: 10.1016/j.cgh.2024.07.033.

20. Murray A, Nguyen TM, Parker CE et al. Oral 5-aminosalicylic acid for maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev 2020; 8 (8): CD000544. doi: 10.1002/14651858.CD000544.pub5.

21. Arzivian A, Rubin DT, Seow CH, The Risk of Relapse Associated With Discontinuation of 5-Aminosalicylates in Inflammatory Bowel Diseases: A Systematic Review and Meta-Analysis. Inflamm Bowel Dis 2025: izaf277. doi: 10.1093/ibd/izaf277.

22. Prokopová L, Ďuricová D, Bortlík et al. Doporučené postupy pro podávání aminosalicylátů u nemocných s idiopatickými střevními záněty. Gastroent Hepatol 2012; 66 (5): 391–400.

23. Löwenberg M, Volkers A, van Gennep S et al. Mercaptopurine for the Treatment of Ulcerative Colitis: A Randomized Placebo-Controlled Trial. J Crohns Colitis 2023; 17 (7): 1055–1065. doi: 10.1093/ecco-jcc/jjad022.

24. Al Abdulqader A, Alnajjar JS, Alzimami L et al. Relapse Rates and Predictors Following Azathioprine Withdrawal in Inflammatory Bowel Disease: A Systematic Review, Meta-Analysis, and Meta-Regression. J Clin Med 2025; 14 (19): 6868. doi: 10.3390/jcm14196868.

25. Jorissen C, Verstockt B, Schils N et al. Long-term clinical outcome after thiopurine discontinuation in elderly IBD patients. Scand J Gastroenterol 2021; 56 (11): 1323–1327. doi: 10.1080/00365521.2021.1965207.

26. Gordon H, Biancone L, Fiorino G et al. ECCO Guidelines on Inflammatory Bowel Disease and Malignancies. J Crohns Colitis 2023; 17 (6): 827–854. doi: 10.1093/ecco-jcc/jjac187.

27. Kruis W, Schutz E, Fric P et al. Double-blind comparison of an oral Escherichia coli preparation and mesalazine in maintaining remission of ulcerative colitis. Aliment Pharmacol Ther 1997; 11 (5): 853–858. doi: 10.1046/j.1365-2036.1997.00225.x.

28. Rembacken BJ, Snelling AM, Hawkey PM et al. Non-pathogenic Escherichia coli versus mesalazine for the treatment of ulcerative colitis: a randomised trial. Lancet 1999; 354 (9179): 635–639. doi: 10.1016/s0140-6736 (98) 06343-0.

29. Kruis W, Fric P, Pokrotnieks J et al. Maintaining remission of ulcerative colitis with the probiotic Escherichia coli Nissle 1917 is as effective as with standard mesalazine. Gut 2004; 53 (11): 1617–1623. doi: 10.1136/gut.2003. 037747.

30. Barberio B, Gracie DJ, Black CJ, Ford AC. Network Meta-Analysis: Efficacy of Biological Therapies and Small Molecules as Maintenance Therapy in Ulcerative Colitis. Aliment Pharmacol Ther 2025; 62 (1): 4–21. doi: 10.1111/apt.70209.

31. Katsoula A, Paschos P, Malandris K et al. Systematic review and network meta-analysis: evaluating the impact of advanced therapies for moderate-to-severe ulcerative colitis on health-related quality of life. J Crohns Colitis 2025; 19 (11): jjaf210. doi: 10.1093/ecco-jcc/ jjaf210.

32. Sul HH, Gewehr DM, Kng H et al. Efficacy of 5-aminosalicylic acid continuation versus discontinuation in patients with ulcerative colitis escalated to advanced therapy: a systematic review and meta analysis of adjusted effect estimates. J Crohn Colitis 2025; 19 (11): jjaf202. doi: 10.1093/ecco-jcc/jjaf202.

33. Cheifetz, AS, Abreu, MT, Afif W et al. A Comprehensive Literature Review and Expert Consensus Statement on Therapeutic Drug Monitoring of Biologics in Inflammatory Bowel Disease. Am J Gastroenterol 2021; 116 (10): 2014–2025. doi: 10.14309/ajg.0000000000001396.

34. Schreiber S, Ben-Horin S, Leszczyszyn J et al. Randomized Controlled Trial: Subcutaneous vs Intravenous Infliximab CT-P13 Maintenance in Inflammatory Bowel Disease. Gastroenterology 2021; 160 (7): 2340–2353. doi: 10.1053/j.gastro.2021.02.068.

35. Iborra M, Caballol B, Garrido A et al. Subcutaneous Infliximab Cutoff Points in Patients With Inflammatory Bowel Disease: Data From the ENEIDA Registry. J Crohns Colitis 2025; 19 (1): jjae127. doi: 10.1093/ecco-jcc/ jjae127.

36. Rautakorpi J, Kolehmainen S, Löyttyniemi E et al. Switching to Subcutaneous Infliximab Maintenance Therapy Is Effective in Patients with Inflammatory Bowel Disease. Dig Dis Sci 2025; 70 (4): 1457–1466. doi: 10.1007/s10620-025-08876-5.

37. Roblin X, Nancey S, Papamichael K et al. Higher Serum Infliximab Concentrations Following Subcutaneous Dosing are Associated with Deep Remission in Patients with Inflammatory Bowel Disease. J Crohn Colitis 2024; 18 (5): 679–685. doi: 10.1093/ecco-jcc/ jjad188.

38. LeBlanc JF, Wiseman D, Lakatos PL et al. Elderly patients with inflammatory bowel disease: Updated review of the therapeutic landscape. World J Gastroenterol 2019; 25 (30): 4158–4171. doi: 10.3748/wjg.v25.i30.4158.

39. Sturm A, Maaser CH, Mendall M et al. European Crohn’s and Colitis Organisation Topical Review on IBD in the Elderly. J Crohns Colitis 2017; 11 (3): 263–273. doi: 10.1093/ecco-jcc/jjw188.

40. Sousa P, Bertani L, Rodrigues C. Management of inflammatory bowel disease in the elderly: A review. Dig Liv Dis 2023; 55 (8): 1001–1009. doi: 10.1016/j.dld.2022.12.024.

41. Bernardi F, Fagiani I, Parigi TL et al. JAK Inhibitors and Risk of Cancer in IBD Patients. Cancers (Basel) 2025; 17 (11): 1795. doi: 10.3390/cancers17111795.

42. Travis S, Silverberg MS, Danese S et al. Vedolizumab for the treatment of chronic pouchitis. N Engl J Med 2023; 388 (13): 1191–1200. doi: 10.1056/NEJMoa2208450.

43. Shen B, Kochhar GS, Rubin DT et al. Treatment of pouchitis, Crohn‘s disease, cuffitis, and other inflammatory disorders of the pouch: consensus guidelines from the International Ileal Pouch Consortium. Lancet Gastroenterol Hepatol 2022; 7 (1): 69–95. doi: 10.1016/S2468-1253 (21) 00214-4.

44. Turner D, Walsh CM, Steinhart AH et al. Response to corticosteroids in severe ulcerative colitis. A systematic review of the literature and a meta-regression. Clin Gastroent Hepatol 2007; 5 (1): 103–110. doi: 10.1016/ j.cgh.2006.09.033.

45. Choy MC, Li Wai Suen CF, Con D et al. Intensified versus standard dose infliximab induction therapy for steroid-refractory acute severe ulcerative colitis (PREDICT-UC): an open-label, multicentre, randomised controlled trial. Lancet Gastroenterol Hepatol 2024; 9 (11): 981–996. doi: 10.1016/S2468-1253 (24) 00200-0.

46. Gisbert JP, Chaparro M. Janus kinase inhibitors in the management of acute severe ulcerative colitis: a comprehensive review. J Crohn Colitis 2025; 19 (2): jjaf021. doi: 10.1093/ecco-jcc/jjaf021.

47. Damianos JA, Osikoya O, Brennan G. Upadacitinib for Acute Severe Ulcerative Colitis: A Systematic Review. Inflamm Bowel Dis 2025; 31 (4): 1145–1149. doi: 10.1093/ibd/ izae191.

48. Singh A, Goyal MK, Midha V et al. Tofacitinib in Acute Severe Ulcerative Colitis (TACOS): A Randomized Controlled Trial. Am J Gastroenterol 2024; 119 (7): 1365–1372. doi: 10.14309/ajg. 0000000000002635.

49. Feagan BG, Sands BE, Sandborn WJ et al. Guselkumab plus golimumab combination therapy versus guselkumab or golimumab monotherapy in patients with ulcerative colitis (VEGA): A randomized, double-blind, controlled phase 2: proof of concept trial. Lancet Gastroenterol Hepatol 2023; 8 (4): 307–320. doi: 10.1016/S2468-1253 (22) 00427-7.

50. Ahmed W, Galati J, Kumar A et al. Dual biologic or small molecule therapy for treatment of inflammatory bowel disease: a systematic review and meta-analysis. Clin Gastro Hepatol 2022; 20 (3): e361–e379. doi: 10.1016/j.cgh.2021.03. 034.

51. Cornet N, Aboubakr A, Ahmed W, Battat R: Combined advanced targeted therapy in inflammatory bowel diseases: An extensive update. Inflamm Bowel Dis 2025; 31 (4): 1138–1144. doi: 10.1093/ibd/izae189.

Doručeno/Submitted: 18. 2. 2026

Přijato/Accepted: 19. 2. 2026

Korespondenční autor

doc. MUDr. Martin Bortlík, Ph.D.

Gastroenterologické oddělení

Nemocnice České Budějovice, a. s.

B. Němcové 585/ 54

370 01 České Budějovice

MBortlik@seznam.cz

Štítky
Dětská gastroenterologie Gastroenterologie a hepatologie Chirurgie všeobecná

Článek vyšel v časopise

Gastroenterologie a hepatologie

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