Area Editoriale
ABSTRACT: There are few published guidelines for the treatment ofinflammatory bowel disease. Physicians choose therapy based on evidence-baseddata, peer and expert opinion, and personal experience. This article providestreatment guidelines for the induction and maintenance of ulcerative proctitisand left-sided colitis and the management of disease refractory to5-aminosalicylic acid (5-ASA) compounds and corticosteroids The guidelines arederived from evidence-based data and, when lacking, expert opinion or theauthors' experience. The comprehensive review of the literature is presented inthe accompanying article, "The Medical Management of Left-Sided UlcerativeColitis and Ulcerative Proctitis: Critical Evaluation of Therapeutic Trials".Rectally administered 5-ASA and corticosteroid suppositories are effectivetreatment for most ulcerative proctitis patients. Corticosteroid and 5-ASAenemas, which reach the splenic flexure of the colon, are recommended forpatients with left-sided ulcerative colitis. The combination of rectallyadministered 5-ASA enemas and oral 5-ASA agents may afford better treatment ofleft-sided colitis and possibly prevent proximal extension of disease. Patientsrefractory to 5-ASAs and corticosteroids may require an immunomodulator orbiological response modifier therapy. Those who have ongoing signs and symptomsof ulcerative proctitis and left-sided ulcerative colitis despite maximalmedical therapy require a proctocolectomy.Leggil'articolo