Indian Journal of Gastroenterology

, Volume 31, Issue 6, pp 307–323

Indian Society of Gastroenterology consensus on ulcerative colitis

  • Balakrishnan S. Ramakrishna
  • Govind K. Makharia
  • Philip Abraham
  • Uday C. Ghoshal
  • Venkataraman Jayanthi
  • Brij Kishore Agarwal
  • Vineet Ahuja
  • Deepak K. Bhasin
  • Shobna J. Bhatia
  • Gourdas Choudhuri
  • Sunil Dadhich
  • Devendra C. Desai
  • Gopal Krishna Dhali
  • Bhaba Dev Goswami
  • Sanjeev K. Issar
  • Ajay K. Jain
  • Rakesh Kochhar
  • Ajay Kumar
  • Goundappa Loganathan
  • Sri Prakash Misra
  • C. Ganesh Pai
  • Sujoy Pal
  • Anna Pulimood
  • Amarender S. Puri
  • Ganesh N. Ramesh
  • Gautam Ray
  • Shivaram P. Singh
  • Ajit Sood
  • Manu Tandan
  • for Indian Society of Gastroenterology Task Force on Inflammatory Bowel Diseases
TASK FORCE REPORT
  • 533 Downloads

Abstract

In 2010, the Indian Society of Gastroenterology’s Task Force on Inflammatory Bowel Diseases undertook an exercise to produce consensus statements on ulcerative colitis. This consensus, produced through a modified Delphi process, reflects our current understanding of the definition, diagnostic work up, treatment and complications of ulcerative colitis. The consensus statements are intended to serve as a reference point for teaching, clinical practice, and research in India.

Keywords

Complications Diagnosis Inflammatory bowel disease Management 

References

  1. 1.
    Makharia GK, Ramakrishna BS, Abraham P, et al. Survey of inflammatory bowel diseases in India. Indian J Gastroenterol. 2012;31: doi:10.1007/s12664-012-0258-1.
  2. 2.
    Linstone H, Turoff M. The Delphi method: techniques and application. http://www.is.njit.edu/pubs/delphibook/. Accessed on August 15, 2012.
  3. 3.
    Periodic health examination: 2. 1984 update. Canadian Task Force on the Periodic Health Examination. Can Med Assoc J. 1984;130:1278–85.Google Scholar
  4. 4.
    Loftus EV Jr,. Clinical epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental influences. Gastroenterology. 2004;126:1504–17.PubMedCrossRefGoogle Scholar
  5. 5.
    Khosla SN, Girdhar NK, Lal S, Mishra DS. Epidemiology of ulcerative colitis and select general population of northern India. J Assoc Physicians India. 1986;34:405–7.PubMedGoogle Scholar
  6. 6.
    Sood A, Midha V, Sood N, et al. Incidence and prevalence of ulcerative colitis in Punjab, North India. Gut. 2003;52:1587–90.PubMedCrossRefGoogle Scholar
  7. 7.
    Yang SK, Yun S, Kim JH, et al. Epidemiology of inflammatory bowel disease in the Songpa-Kangdong district, Seoul, Korea, 1986–2005: a KASID study. Inflamm Bowel Dis. 2008;14:542–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Lok KH, Hung HG, Ng CH, et al. Epidemiology and clinical characteristics of ulcerative colitis in Chinese population: experience from a single center in Hong Kong. J Gastroenterol Hepatol. 2008;23:406–10.PubMedCrossRefGoogle Scholar
  9. 9.
    Chow DK, Leong RW, Tsoi KK, et al. Long-term follow-up of ulcerative colitis in the Chinese population. Am J Gastroenterol. 2009;104:647–54.PubMedCrossRefGoogle Scholar
  10. 10.
    Morita N, Toki S, Hirohashi T, et al. Incidence and prevalence of inflammatory bowel disease in Japan: nationwide epidemiological survey during the year 1991. J Gastroenterol. 1995;30 Suppl 8:1–4.Google Scholar
  11. 11.
    Lee YM, Fock K, See SJ, Ng TM, Khor C, Teo EK. Racial differences in the prevalence of ulcerative colitis and Crohn’s disease in Singapore. J Gastroenterol Hepatol. 2000;15:622–5.PubMedCrossRefGoogle Scholar
  12. 12.
    Ling KL, Ooi CJ, Luman W, Cheong WK, Choen FS, Ng HS. Clinical characteristics of ulcerative colitis in Singapore, a multiracial city-state. J Clin Gastroenterol. 2002;35:144–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Tan YM, Goh KL. Ulcerative colitis in a multiracial Asian country: racial differences and clinical presentation among Malaysian patients. World J Gastroenterol. 2005;11:5859–62.PubMedGoogle Scholar
  14. 14.
    Probert CS, Mayberry JF, Mann R. Inflammatory bowel disease in the rural Indian subcontinent: a survey of patients attending mission hospitals. Digestion. 1990;47:42–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Maroo MK, Nag NK, Sortur SV, Patil RS. Ulcerative colitis in Southern Maharashtra. J Indian Med Assoc. 1974;63:350–4.PubMedGoogle Scholar
  16. 16.
    Tandon BN, Mathur AK, Mohapatra LN, Tandon HD, Wig KL. A study of the prevalence and clinical pattern of non-specific ulcerative colitis in northern India. Gut. 1965;6:448–53.PubMedCrossRefGoogle Scholar
  17. 17.
    Sood A, Midha V. Epidemiology of inflammatory bowel disease in Asia. Indian J Gastroenterol. 2007;26:285–9.PubMedGoogle Scholar
  18. 18.
    Satsangi J, Jewell DP, Rosenberg WM, Bell JI. Genetics of inflammatory bowel disease. Gut. 1994;35:696–700.PubMedCrossRefGoogle Scholar
  19. 19.
    Jiang L, Xia B, Li J, et al. Risk factors for ulcerative colitis in a Chinese population: an age-matched and sex-matched case–control study. J Clin Gastroenterol. 2007;41:280–4.PubMedCrossRefGoogle Scholar
  20. 20.
    Kitahora T, Utsunomiya T, Yokota A. Epidemiological study of ulcerative colitis in Japan: incidence and familial occurrence. The Epidemiology Group of the Research Committee of Inflammatory Bowel Disease in Japan. J Gastroenterol. 1995;30 Suppl 8:5–8.Google Scholar
  21. 21.
    Park JB, Yang SK, Byeon JS, et al. Familial occurrence of inflammatory bowel disease in Korea. Inflamm Bowel Dis. 2006;12:1146–51.PubMedCrossRefGoogle Scholar
  22. 22.
    Probert CS, Jayanthi V, Hughes AO, Thompson JR, Wicks AC, Mayberry JF. Prevalence and family risk of ulcerative colitis and Crohn's disease: an epidemiological study among Europeans and south Asians in Leicestershire. Gut. 1993;34:1547–51.PubMedCrossRefGoogle Scholar
  23. 23.
    Probert CS, Jayanthi V, Pinder D, et al. Epidemiological study of ulcerative proctocolitis in Indian migrants and the indigenous population of Leicestershire. Gut. 1992;33:687–93.PubMedCrossRefGoogle Scholar
  24. 24.
    Carr I, Mayberry JF. The effects of migration on ulcerative colitis: a three-year prospective study among Europeans and first and second-generation South Asians in Leicester (1991–1994). Am J Gastroenterol. 1999;94:2918–22.PubMedGoogle Scholar
  25. 25.
    Jayanthi V, Probert CS, Pollock DJ, et al. Low incidence of ulcerative colitis and proctitis in Bangladeshi migrants in Britain. Digestion. 1992;52:34–42.PubMedCrossRefGoogle Scholar
  26. 26.
    Probert CS, Jayanthi V, Mayberry JF. Inflammatory bowel disease in Indian migrants in Fiji. Digestion. 1991;50:82–4.PubMedCrossRefGoogle Scholar
  27. 27.
    Rajput HI, Seebaran AR, Desai Y. Ulcerative colitis in the Indian population of Durban. S Afr Med J. 1992;81:245–8.PubMedGoogle Scholar
  28. 28.
    Kochhar R, Mehta SK, Nagi B, Bhatia V, Goenka MA, Malik AK. Extraintestinal manifestations in idiopathic ulcerative colitis. Indian J Gastroenterol. 1991;10:88–9.PubMedGoogle Scholar
  29. 29.
    Pokharna RK, Kabra PK, Sharma P, Kochar DK. Extraintestinal manifestations of idiopatic ulcerative colitis in north western India. Indian J Gastroenterol. 2004;123:89–90.Google Scholar
  30. 30.
    Chandrasekaran AN, Porkodi R, Madhavan R, Sambandam PR, Jayanthi V, Ramathilagam B. Spectrum of clinical and immunological features of systemic rheumatic disorders in a referral hospital in south India: arthritis in ulcerative colitis. J Indian Rheumat Assoc. 1995;3:43–7.Google Scholar
  31. 31.
    Habeeb MA, Rajalingam R, Dhar A, Kumar A, Sharma MP, Mehra NK. HLA association and occurrence of autoantibodies in Asian patients with ulcerative colitis. Am J Gastroenterol. 1997;92:772–6.PubMedGoogle Scholar
  32. 32.
    Kornbluth A, Sachar DB. Ulcerative colitis practice guidelines in adults (update): American College of Gastroenterology. Practice Parameters Committee. Am J Gastroenterol. 2004;99:1371–85.PubMedCrossRefGoogle Scholar
  33. 33.
    Carter MJ, Lobo AJ, Travis SP. Guidelines for the management of inflammatory bowel disease in adults. Gut. 2004;53 Suppl 5:V1–16.Google Scholar
  34. 34.
    Stange EF, Travis SP, Vermeire S, et al. European evidence-based Consensus on the diagnosis and management of ulcerative colitis: definitions and diagnosis. J Crohn’s Colitis. 2008;2:1–23.CrossRefGoogle Scholar
  35. 35.
    Ooi CJ, Fock KM, Makharia GK, et al. The Asia-Pacific consensus on ulcerative colitis. J Gastroenterol Hepatol. 2010;25:453–68.PubMedCrossRefGoogle Scholar
  36. 36.
    Tedesco FJ, Hardin RD, Harper RN, Edwards BH. Infectious colitis endoscopically simulating inflammatory bowel disease: a prospective evaluation. Gastrointest Endosc. 1983;29:195–7.PubMedCrossRefGoogle Scholar
  37. 37.
    Dunzendorfer T, Kasznica J. Amebic and/or ulcerative colitis? Gastrointest Endosc. 1998;48:450–1.PubMedCrossRefGoogle Scholar
  38. 38.
    Misra SP, Misra V, Dwivedi M, Singh PA. Colonic tuberculosis mimicking ulcerative colitis. J Assoc Physicians India. 1998;46:309–10.PubMedGoogle Scholar
  39. 39.
    Chodos JE. Campylobacter infection mimicking ulcerative colitis. NY State J Med. 1986;86:22–3.Google Scholar
  40. 40.
    Ibrahim TM, Iheonunekwu N, Gill V, Vantapool H. Differentiating amoebic ulcero-haemorrhagic recto-colitis from idiopathic inflammatory bowel disease: still a diagnostic dilemma. West Indian Med J. 2005;54:210–12.PubMedCrossRefGoogle Scholar
  41. 41.
    Mann EA, Saeed SA. Gastrointestinal infection as a trigger for inflammatory bowel disease. Curr Opin Gastroenterol. 2012;28:24–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Khuroo MS, Mahajan R, Zargar SA, et al. The colon in shigellosis: serial colonoscopic appearances in Shigella dysenteriae I. Endoscopy. 1990;22:35–8.PubMedCrossRefGoogle Scholar
  43. 43.
    Kochhar R, Ayyagari A, Goenka MK, Dhali GK, Aggarwal R, Mehta SK. Role of infectious agents in exacerbations of ulcerative colitis in India. A study of Clostridium difficile. J Clin Gastroenterol. 1993;16:26–30.PubMedCrossRefGoogle Scholar
  44. 44.
    Kishore J, Ghoshal U, Ghoshal UC, et al. Infection with cytomegalovirus in patients with inflammatory bowel disease: prevalence, clinical significance and outcome. J Med Microbiol. 2004;53:1155–60.Google Scholar
  45. 45.
    Banerjee D, Deb R, Dar L, et al. High frequency of parasitic and viral stool pathogens in patients with active ulcerative colitis: report from a tropical country. Scand J Gastroenterol. 2009;44:325–31.PubMedCrossRefGoogle Scholar
  46. 46.
    Roblin X, Pillet S, Oussalah A, et al. Cytomegalovirus load in inflamed intestinal tissue is predictive of resistance to immunosuppressive therapy in ulcerative colitis. Am J Gastroenterol. 2011;106:2001–8.PubMedCrossRefGoogle Scholar
  47. 47.
    Vaishnavi C, Kochhar R, Bhasin D, Thennarasu K, Singh K. Simultaneous assays for Clostridium difficile and faecal lactoferrin in ulcerative colitis. Trop Gastroenterol. 2003;24:13–6.PubMedGoogle Scholar
  48. 48.
    Kashyap B, Sinha S, Das S, Rustagi N, Jhamb R. Efficiency of diagnostic methods for correlation between prevalence of enteric protozoan parasites and HIV/AIDS status––an experience of a tertiary care hospital in East Delhi. J Parasit Dis. 2010;34:63–7.PubMedCrossRefGoogle Scholar
  49. 49.
    Montes M, Sawhney C, Barros N. Strongyloides stercoralis: there but not seen. Curr Opin Infect Dis. 2010;23:500–4.PubMedCrossRefGoogle Scholar
  50. 50.
    Navarro-Llavat M, Domènech E, Bernal I, et al. Prospective, observational, cross-sectional study of intestinal infections among acutely active inflammatory bowel disease patients. Digestion. 2009;80:25–9.PubMedCrossRefGoogle Scholar
  51. 51.
    Vaishnavi C. Clostridium difficile infection: clinical spectrum and approach to management. Indian J Gastroenterol. 2011;30:245–54.PubMedCrossRefGoogle Scholar
  52. 52.
    Lawlor G, Moss AC. Cytomegalovirus in inflammatory bowel disease: pathogen or innocent bystander? Inflamm Bowel Dis. 2010;16:1620–7.PubMedCrossRefGoogle Scholar
  53. 53.
    Sung JJY, Kamm MA, Marteau P. Asian perspectives in the management of inflammatory bowel disease: findings from a recent survey. J Gastroenterol Hepatol. 2010;25:183–93.PubMedCrossRefGoogle Scholar
  54. 54.
    Schusselé Filliettaz S, Juillerat P, Burnand B, et al. Appropriateness of colonoscopy in Europe (EPAGE II). Chronic diarrhea and known inflammatory bowel disease. Endoscopy. 2009;41:218–26.PubMedCrossRefGoogle Scholar
  55. 55.
    Louis E, Belaiche J, Reenaers C. Do clinical factors help to predict disease course in inflammatory bowel disease? World J Gastroenterol. 2010;16:2600–3.PubMedCrossRefGoogle Scholar
  56. 56.
    Regueiro M, Loftus EV, Steinhart AH, Cohen RD. Medical management of left-sided ulcerative colitis and ulcerative proctitis: Critical evaluation of therapeutic trials. Inflamm Bowel Dis. 2006;12:979–94.PubMedCrossRefGoogle Scholar
  57. 57.
    Kochhar R, Goenka MK, Kaushik SP, Gupta NM, Nagi B, Mehta SK. Colorectal carcinoma in Indian patients with idiopathic ulcerative colitis. Eur J Cancer Prev. 1992;1:293–6.PubMedCrossRefGoogle Scholar
  58. 58.
    Venkataraman S, Mohan V, Ramakrishna BS, et al. Risk of colorectal cancer in ulcerative colitis in India. J Gastroenterol Hepatol. 2005;20:705–9.PubMedCrossRefGoogle Scholar
  59. 59.
    Regueiro M, Rodemann J, Kip KE, et al. Physician assessment of ulcerative colitis activity correlates poorly with endoscopic disease activity. Inflamm Bowel Dis. 2011;17:1008–14.PubMedCrossRefGoogle Scholar
  60. 60.
    Satsangi J, Silverberg MS, Vermeire S, Colombel JF. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut. 2006;55:749–53.PubMedCrossRefGoogle Scholar
  61. 61.
    Naber AHJ, de Jong DJ. Assessment of disease activity in inflammatory bowel disease; relevance for clinical trials. Neth J Med. 2003;61:105–10.PubMedGoogle Scholar
  62. 62.
    Thia KT, Loftus EV Jr, Pardi DS, et al. Measurement of disease activity in ulcerative colitis: interobserver agreement and predictors of severity. Inflamm Bowel Dis. 2011;17:1257–64.PubMedCrossRefGoogle Scholar
  63. 63.
    Bhatt J, Patil S, Joshi A, Abraham P, Desai D. Self-reported treatment adherence in inflammatory bowel disease in Indian patients. Indian J Gastroenterol. 2009;28:143–6.PubMedCrossRefGoogle Scholar
  64. 64.
    Gionchetti P, Rizzello F, Morselli C, Tambasco R, Campieri M. Review article: aminosalicylates for distal colitis. Aliment Pharmacol Ther. 2006;24 Suppl 3:41–4.Google Scholar
  65. 65.
    Cohen RD, Woseth DM, Thisted RA, Hanauer SB. A meta-analysis and overview of the literature on treatment options for left-sided ulcerative colitis and ulcerative proctitis. Am J Gastroenterol. 2000;95:1263–76.PubMedCrossRefGoogle Scholar
  66. 66.
    Marshall JK, Irvine EJ. Rectal corticosteroids versus alternative treatments in ulcerative colitis: a meta-analysis. Gut. 1997;40:775–81.PubMedCrossRefGoogle Scholar
  67. 67.
    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 Syst Rev. 2010;(1):CD004115.Google Scholar
  68. 68.
    Campieri M, De Franchis R, Bianchi Porro G, et al. Mesalazine (5-aminosalicylic acid) suppositories in the treatment of ulcerative proctitis or distal proctosigmoiditis. A randomized controlled trial. Scand J Gastroenterol. 1990;25:663–8.PubMedCrossRefGoogle Scholar
  69. 69.
    D’Arienzo A, Panarese A, D’Armiento FP, et al. 5-Aminosalicylic acid suppositories in the maintenance of remission in idiopathic proctitis or proctosigmoiditis: a double-blind placebo-controlled clinical trial. Am J Gastroenterol. 1990;85:1079–82.PubMedGoogle Scholar
  70. 70.
    Hanauer SB. Dose-ranging study of mesalamine (PENTASA) enemas in the treatment of acute ulcerative proctosigmoiditis: results of a multicentered placebo-controlled trial. The US PENTASA Enema Study Group. Inflamm Bowel Dis. 1998;4:79–83.PubMedCrossRefGoogle Scholar
  71. 71.
    Biddle WL, Greenberger NJ, Swan JT, et al. 5-Aminosalicylic acid enemas: effective agent in maintaining remission in left -sided ulcerative colitis. Gastroenterology. 1988;94:1075–9.PubMedGoogle Scholar
  72. 72.
    Sutherland L, Macdonald JK. Oral 5-aminosalicylic acid for maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev. 2006;(2):D000544.Google Scholar
  73. 73.
    Baron JH, Connell AM, Lennard-Jones JE, et al. Sulphasalazine and salicylazosulphadimidine in ulcerative colitis. Lancet. 1962;1:1094–6.PubMedCrossRefGoogle Scholar
  74. 74.
    Sutherland L, Macdonald JK. Oral 5-aminosalicylic acid for induction of remission in ulcerative colitis. Cochrane Database Syst Rev. 2006;(2):CD000543.Google Scholar
  75. 75.
    Kamm MA, Lichtenstein GR, Sandborn WJ, et al. Effect of extended MMX mesalamine therapy for acute, mild-to-moderate ulcerative colitis. Inflamm Bowel Dis. 2009;15:1–8.PubMedCrossRefGoogle Scholar
  76. 76.
    Kamm MA, Lichtenstein GR, Sandborn WJ, et al. Randomised trial of once or twice-daily MMX mesalazine for maintenance of remission in ulcerative colitis. Gut. 2008;57:893–902.PubMedCrossRefGoogle Scholar
  77. 77.
    Safdi M, DeMicco M, Sninsky C, et al. A double-blind comparison of oral versus rectal mesalamine versus combination therapy in the treatment of distal ulcerative colitis. Am J Gastroenterol. 1997;92:1867–71.PubMedGoogle Scholar
  78. 78.
    Faubion Jr WA, Loftus Jr EV, Harmsen WS, Zinsmeister AR, Sandborn WJ. The natural history of corticosteroid therapy for inflammatory bowel disease: a population-based study. Gastroenterology. 2001;121:255–60.PubMedCrossRefGoogle Scholar
  79. 79.
    Truelove SC, Watkinson G, Draper G. Comparison of corticosteroid and SASP therapy in ulcerative colitis. Br Med J. 1962;2:1708–11.PubMedCrossRefGoogle Scholar
  80. 80.
    Lennard-Jones JE, Longmore AJ, Newell AC, Wilson CWE, Avery Jones F. An assessment of prednisone, Salazopyrin and topicalhydrocortisone hemisuccinate used as outpatient treatment for ulcerative colitis. Gut. 1960;1:217–22.PubMedCrossRefGoogle Scholar
  81. 81.
    Baron JH, Connell AM, Kanaghinis TG, et al. Outpatient treatment of ulcerative colitis: comparison between three doses of oral prednisone. Br Med J. 1962;2:441–3.PubMedCrossRefGoogle Scholar
  82. 82.
    Rosenberg W, Ireland A, Jewell DP. High-dose methylprednisolone in the treatment of active ulcerative colitis. J Clin Gastroenterol. 1990;12:40–1.PubMedCrossRefGoogle Scholar
  83. 83.
    Lichtenstein GR, Abreu MT, Cohen R, Tremaine W. American Gastroenterological Association. American Gastroenterological Association Institute technical review on corticosteroids, immunomodulators, and infliximab in inflammatory bowel disease. Gastroenterology. 2006;130:940–87.PubMedCrossRefGoogle Scholar
  84. 84.
    Truelove SC, Jewell DP. Intensive intravenous regimen for severe attacks of ulcerative colitis. Lancet. 1974;i:1067–70.CrossRefGoogle Scholar
  85. 85.
    Turner D, Walsh C, Steinhart AH, Griffiths AM. Response to corticosteroids in severe ulcerative colitis: a systematic review of the literature and a meta-regression. Clin Gastroenterol Hepatol. 2007;5:103–10.PubMedCrossRefGoogle Scholar
  86. 86.
    Ardizzone S, Maconi G, Russo A, Imbesi V, Colombo E, Bianchi Porro G. Randomised controlled trial of azathioprine and 5-aminosalicylic acid for treatment of steroid dependent ulcerative colitis. Gut. 2006;55:47–53.PubMedCrossRefGoogle Scholar
  87. 87.
    Timmer A, McDonald JW, Macdonald JK. Azathioprine and 6-mercaptopurine for maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev. 2007;(1):CD000478.Google Scholar
  88. 88.
    Etchevers MJ, Aceituno M, Sans M. Are we giving azathioprine too late? The case for early immunomodulation in inflammatory bowel disease. World J Gastroenterol. 2008;14:5512–8.PubMedCrossRefGoogle Scholar
  89. 89.
    Adler DJ, Korelitz BI. The therapeutic efficacy of 6-mercaptopurine in refractory ulcerative colitis. Am J Gastroenterol. 1990;85:717–22.PubMedGoogle Scholar
  90. 90.
    Leung Y, Panaccione R, Hemmelgarn B, Jones J. Exposing the weaknesses: a systematic review of azathioprine efficacy in ulcerative colitis. Dig Dis Sci. 2008;53:1455–61.PubMedCrossRefGoogle Scholar
  91. 91.
    Sood A, Kaushal V, Midha V, Bhatia KL, Sood N, Malhotra V. The beneficial effect of azathioprine on maintenance of remission in severe ulcerative colitis. J Gastroenterol. 2002;37:270–4.PubMedCrossRefGoogle Scholar
  92. 92.
    Hibi T, Naganuma M, Kitahora T, Kinjyo F, Shimoyama T. Low-dose azathioprine is effective and safe for maintenance of remission in patients with ulcerative colitis. J Gastroenterol. 2003;38:740–6.PubMedCrossRefGoogle Scholar
  93. 93.
    Sood A, Midha V, Sood N, Avasthi G. Azathioprine versus sulfasalazine in maintenance of remission in severe ulcerative colitis. Indian J Gastroenterol. 2003;22:79–81.PubMedGoogle Scholar
  94. 94.
    Sood A, Midha V, Sood N, Bansal M. Long term results of use of azathioprine in patients with ulcerative colitis in India. World J Gastroenterol. 2006;12:7332–6.PubMedGoogle Scholar
  95. 95.
    Lichtenstein GR. Use of laboratory testing to guide 6-mercaptopurine/azathioprine therapy. Gastroenterology. 2004;127:1558–64.PubMedCrossRefGoogle Scholar
  96. 96.
    Desire S, Balasubramanian P, Bajel A, et al. Frequency of TPMT alleles in Indian patients with acute lymphatic leukemia and effect on the dose of 6-mercaptopurine. Med Oncol. 2010;27:1046–9.PubMedCrossRefGoogle Scholar
  97. 97.
    Kham SK, Tan PL, Tay AH, Heng CK, Yeoh AE, Quah TC. Thiopurine methyltransferase polymorphisms in a multiracial Asian population and children with acute lymphoblastic leukemia. J Pediatr Hematol Oncol. 2002;24:353–9.PubMedCrossRefGoogle Scholar
  98. 98.
    Ashavaid TF, Raghavan R, Shah S, Kapadia A, Almel S, Desai D. TPMT and DPD polymorphisms: efficient screening method for Indian patients considering taking thiopurine and 5-FU drugs. Dis Markers. 2009;27:231–8.PubMedGoogle Scholar
  99. 99.
    Lichtiger S, Present DH, Kornbluth A, et al. Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med. 1994;330:1841–5.PubMedCrossRefGoogle Scholar
  100. 100.
    Van Assche G, D’Haens G, Noman M, et al. Randomized, double-blind comparison of 4 mg/kg versus 2 mg/kg intravenous cyclosporine in severe ulcerative colitis. Gastroenterology. 2003;125:1025–31.PubMedCrossRefGoogle Scholar
  101. 101.
    Sood A, Midha V, Sood N, et al. Cyclosporine in the treatment of severe steroid refractory ulcerative colitis: a retrospective analysis of 24 cases. Indian J Gastroenterol. 2008;27:232–5.PubMedGoogle Scholar
  102. 102.
    Lawson MM, Thomas AG, Akobeng AK. Tumour necrosis factor alpha blocking agents for induction of remission in ulcerative colitis. Cochrane Database Syst Rev. 2006;(3):CD005112.Google Scholar
  103. 103.
    Rutgeerts P, Sandborn WJ, Feagan BG, et al. Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2005;353:2462–76.PubMedCrossRefGoogle Scholar
  104. 104.
    Mowat C, Cole A, Windsor A, et al. Guidelines for the management of inflammatory bowel disease in adults. Gut. 2011;60:571–607.PubMedCrossRefGoogle Scholar
  105. 105.
    Nordgaard-Lassen I, Dahlerup JF, Belard E, et al. Guidelines for screening, prophylaxis and critical information prior to initiating anti-TNF-alpha treatment. Dan Med J. 2012;59:C4480.PubMedGoogle Scholar
  106. 106.
    Millonig G, Kern M, Ludwiczek O, Nachbaur K, Vogel W. Subfulminant hepatitis B after infliximab in Crohn's disease: need for HBV-screening? World J Gastroenterol. 2006;12:974–6.PubMedGoogle Scholar
  107. 107.
    Colbert C, Chavarria A, Berkelhammer C. Fulminant hepatic failure in chronic hepatitis B on withdrawal of corticosteroids, azathioprine and infliximab for Crohn's disease. Inflamm Bowel Dis. 2007;13:1453–4.PubMedCrossRefGoogle Scholar
  108. 108.
    Katz LH, Fraser A, Gafter-Gvili A, Leibovici L, Tur-Kaspa R. Lamivudine prevents reactivation of hepatitis B and reduces mortality in immunosuppressed patients: systematic review and meta-analysis. J Viral Hepat. 2008;15:89–102.PubMedGoogle Scholar
  109. 109.
    Viazis N, Vlachogiannakos J, Georgiou O, et al. Course of inflammatory bowel disease in patients infected with human immunodeficiency virus. Inflamm Bowel Dis. 2010;16:507–11.PubMedGoogle Scholar
  110. 110.
    Shale MJ, Seow CH, Coffin CS, Kaplan GG, Panaccione R, Ghosh S. Review article: chronic viral infection in the anti-tumour necrosis factor therapy era in inflammatory bowel disease. Aliment Pharmacol Ther. 2010;31:20–34.PubMedCrossRefGoogle Scholar
  111. 111.
    Wilckens V, Kannengiesser K, Hoxhold K, Frenkel C, Kucharzik T, Maaser C. The immunization status of patients with IBD is alarmingly poor before the introduction of specific guidelines. Scand J Gastroenterol. 2011;46:855–61.PubMedCrossRefGoogle Scholar
  112. 112.
    Pal S, Sahni P, Pande GK, Acharya SK, Chattopadhyay TK. Outcome following emergency surgery for refractory severe ulcerative colitis in a tertiary care centre in India. BMC Gastroenterol. 2005;5:39.PubMedCrossRefGoogle Scholar
  113. 113.
    Cima RR. Timing and indications for colectomy in chronic ulcerative colitis: Surgical consideration. Dig Dis. 2010;28:501–7.PubMedCrossRefGoogle Scholar
  114. 114.
    Van Assche G, Vermeire S, Rutgeerts P. Management of acute severe ulcerative colitis. Gut. 2011;60:130–3.PubMedCrossRefGoogle Scholar
  115. 115.
    Travis S, Satsangi J, Lémann M. Predicting the need for colectomy in severe ulcerative colitis: a critical appraisal of clinical parameters and currently available biomarkers. Gut. 2011;60:3–9.PubMedCrossRefGoogle Scholar
  116. 116.
    Randall J, Singh B, Warren BF, Travis SP, Mortensen NJ, George BD. Delayed surgery for acute severe colitis is associated with increased risk of postoperative complications. Br J Surg. 2010;97:404–9.PubMedCrossRefGoogle Scholar
  117. 117.
    Selvasekar CR, Cima RR, Larson DW, et al. Effect of infliximab on short term complications in patients undergoing operation for chronic ulcerative colitis. J Am Coll Surg. 2007;204:956–62.PubMedCrossRefGoogle Scholar
  118. 118.
    Koltun WA. Role of medical rescue therapy in the management of acute severe ulcerative colitis: the surgical perspective. Expert Rev Gastroenterol Hepatol. 2009;3:325–7.PubMedCrossRefGoogle Scholar
  119. 119.
    Andersson P, Söderholm JD. Surgery in ulcerative colitis: indication and timing. Dig Dis. 2009;27:335–40.PubMedCrossRefGoogle Scholar
  120. 120.
    Rao YG, Saxena R, Sahni P, Pande GK, Chattopadhyay TK. Functional outcome and patient satisfaction after ileal pouch anal anastomosis for ulcerative colitis in a developing country. Trop Gastroenterol. 2002;23:66–9.PubMedGoogle Scholar
  121. 121.
    Somashekar U, Gupta S, Soin A, Nundy S. Functional outcome and quality of life following restorative proctocolectomy for ulcerative colitis in Indians. Int J Colorectal Dis. 2010;25:967–73.PubMedCrossRefGoogle Scholar
  122. 122.
    Odze RD. Adenomas and adenoma-like DALMs in chronic ulcerative colitis: a clinical, pathological, and molecular review. Am J Gastroenterol. 1999;94:1746–50.PubMedCrossRefGoogle Scholar
  123. 123.
    Vleggaar FP, Lutgens MW, Claessen MM. Review article: the relevance of surveillance endoscopy in long-lasting inflammatory bowel disease. Aliment Pharmacol Ther. 2007;26 Suppl 2:47–52.Google Scholar
  124. 124.
    Thomas T, Nair P, Dronfield MW, Mayberry JF. Management of low and high-grade dysplasia in inflammatory bowel disease: the gastroenterologists' perspective and current practice in the United Kingdom. Eur J Gastroenterol Hepatol. 2005;17:1317–24.PubMedCrossRefGoogle Scholar
  125. 125.
    Eaden JA, Mayberry JF. Guidelines for screening and surveillance of asymptomatic colorectal cancer in patients with inflammatory bowel disease. Gut. 2002;51 Suppl 5:V10–12.Google Scholar
  126. 126.
    Bernstein CN, Leslie WD, Leboff MS. AGA technical review on osteoporosis in gastrointestinal diseases. Gastroenterology. 2003;124:795–841.PubMedCrossRefGoogle Scholar
  127. 127.
    Loftus EV Jr, Achenbach SJ, Sandborn WJ, Tremaine WJ, Oberg AL, Melton LJ 3rd. Risk of fracture in ulcerative colitis: a population-based study from Olmsted County, Minnesota. Clin Gastroenterol Hepatol. 2003;1:465–73.PubMedCrossRefGoogle Scholar
  128. 128.
    Vestergaard P, Mosekilde L. Fracture risk in patients with celiac disease, Crohn's disease, and ulcerative colitis: a nationwide follow-up study of 16,416 patients in Denmark. Am J Epidemiol. 2002;156:1–10.PubMedCrossRefGoogle Scholar
  129. 129.
    Ezzat Y, Hamdy K. The frequency of low bone mineral density and its associated risk factors in patients with inflammatory bowel diseases. Int J Rheum Dis. 2010;13:259–65.PubMedCrossRefGoogle Scholar
  130. 130.
    Navaneethan U, Shen L, Venkatesh PG, et al. Influence of ileal pouch anal anastomosis on bone loss in ulcerative colitis patients. J Crohns Colitis. 2011;5:415–22.PubMedCrossRefGoogle Scholar
  131. 131.
    Shen B, Remzi FH, Oikonomou IK, et al. Risk factors for low bone mass in patients with ulcerative colitis following ileal pouch-anal anastomosis. Am J Gastroenterol. 2009;104:639–46.PubMedCrossRefGoogle Scholar
  132. 132.
    Khadgawat R, Makharia GK, Puri K. Evaluation of bone mineral density among patients with inflammatory bowel disease in a tertiary care setting in India. Indian J Gastroenterol. 2008;27:103–6.PubMedGoogle Scholar
  133. 133.
    Jowett SL, Seal CJ, Phillips E, Gregory W, Barton JR, Welfare MR. Dietary beliefs of people with ulcerative colitis and their effect on relapse and nutrient intake. Clin Nutr. 2004;23:161–70.PubMedCrossRefGoogle Scholar
  134. 134.
    Bernstein CN, Ament M, Artinian L, Ridgeway J, Shanahan F. Milk tolerance in adults with ulcerative colitis. Am J Gastroenterol. 1994;89:872–7.PubMedGoogle Scholar
  135. 135.
    Chaves S, Perdigon G, de Moreno de LeBlanc A. Yoghurt consumption regulates the immune cells implicated in acute intestinal inflammation and prevents the recurrence of the inflammatory process in a mouse model. J Food Prot. 2011;74:801–11.PubMedCrossRefGoogle Scholar
  136. 136.
    Elahi B, Nikfar S, Derakhshani S, Vafaie M, Abdollahi M. On the benefit of probiotics in the management of pouchitis in patients underwent ileal pouch anal anastomosis: a meta-analysis of controlled clinical trials. Dig Dis Sci. 2008;53:1278–84.PubMedCrossRefGoogle Scholar
  137. 137.
    Rembacken BJ, Snelling AM, Hawkey PM, Chalmers DM, Axon AT. Non-pathogenic Escherichia coli versus mesalazine for the treatment of ulcerative colitis: a randomised trial. Lancet. 1999;354:635–9.PubMedCrossRefGoogle Scholar
  138. 138.
    Mallon P, McKay D, Kirk S, Gardiner K. Probiotics for induction of remission in ulcerative colitis. Cochrane Database Syst Rev. 2007;(4):CD005573.Google Scholar
  139. 139.
    Do VT, Baird BG, Kockler DR. Probiotics for maintaining remission of ulcerative colitis in adults. Ann Pharmacother. 2010;44:565–71.PubMedCrossRefGoogle Scholar
  140. 140.
    Jonkers D, Penders J, Masclee A, Pierik M. Probiotics in the management of inflammatory bowel disease: a systematic review of intervention studies in adult patients. Drugs. 2012;72:803–23.PubMedCrossRefGoogle Scholar
  141. 141.
    Sood A, Midha V, Makharia GK, et al. The probiotic preparation, VSL#3 induces remission in patients with mild-to-moderately active ulcerative colitis. Clin Gastroenterol Hepatol. 2009;7:1202–9.PubMedCrossRefGoogle Scholar
  142. 142.
    Cornish J, Tan E, Teare J, et al. A meta-analysis on the influence of inflammatory bowel disease on pregnancy. Gut. 2007;56:830–7.PubMedCrossRefGoogle Scholar
  143. 143.
    Uribe M, Chavez-Tapia NC, Mendez-Sanchez N. Pregnancy and autoimmune hepatitis. Ann Hepatol. 2006;5:187–9.PubMedGoogle Scholar
  144. 144.
    Warrell DW, Taylor R. Outcome for the foetus of mothers receiving prednisolone during pregnancy. Lancet. 1968;1:117–8.PubMedCrossRefGoogle Scholar
  145. 145.
    Ham M, Moss AC. Mesalamine in the treatment and maintenance of remission of ulcerative colitis. Expert Rev Clin Pharmacol. 2012;5:113–23.PubMedCrossRefGoogle Scholar
  146. 146.
    Schirbel A, Sturm A. Imaging in inflammatory bowel disease: mucosal healing in ulcerative colitis: relevance for clinical outcomes. Curr Drug Targets. 2012; May 28. [Epub ahead of print].Google Scholar
  147. 147.
    Hanauer SB. Review article: the long-term management of ulcerative colitis. Aliment Pharmacol Ther. 2004;20 Suppl 4:97–101.PubMedCrossRefGoogle Scholar
  148. 148.
    Stolfi C, Pellegrini R, Franze E, Pallone F, Monteleone G. Molecular basis of the potential of mesalazine to prevent colorectal cancer. World J Gastroenterol. 2008;14:4434–9.PubMedCrossRefGoogle Scholar
  149. 149.
    Levine JS, Burakoff R. Chemoprophylaxis of colorectal cancer in inflammatory bowel disease: current concepts. Inflamm Bowel Dis. 2007;13:1293–8.PubMedCrossRefGoogle Scholar
  150. 150.
    Ullman T, Croog V, Harpaz N, et al. Progression to colorectal neoplasia in ulcerative colitis: effect of mesalamine. Clin Gastroenterol Hepatol. 2008;6:1225–30.PubMedCrossRefGoogle Scholar
  151. 151.
    Bernstein CN, Nugent Z, Blanchard JF. 5-aminosalicylate is not chemoprophylactic for colorectal cancer in IBD: a population based study. Am J Gastroenterol. 2011;106:731–6.PubMedCrossRefGoogle Scholar
  152. 152.
    Ardizzone S, Porro GB. How long is it advisable to prolong maintenance treatment of patients with ulcerative colitis? Inflamm Bowel Dis. 2008;14 Suppl 2:S238–9.PubMedCrossRefGoogle Scholar
  153. 153.
    Kamm MA. Review article: maintenance of remission in ulcerative colitis. Aliment Pharmacol Ther. 2002;16 Suppl 4:21–4.PubMedCrossRefGoogle Scholar
  154. 154.
    Sutherland L, Macdonald JK. Oral 5-aminosalicylic acid for maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev. 2006;(2):CD000544.Google Scholar

Copyright information

© Indian Society of Gastroenterology 2012

Authors and Affiliations

  • Balakrishnan S. Ramakrishna
    • 1
  • Govind K. Makharia
    • 2
  • Philip Abraham
    • 3
  • Uday C. Ghoshal
    • 4
  • Venkataraman Jayanthi
    • 5
  • Brij Kishore Agarwal
    • 6
  • Vineet Ahuja
    • 2
  • Deepak K. Bhasin
    • 7
  • Shobna J. Bhatia
    • 8
  • Gourdas Choudhuri
    • 4
  • Sunil Dadhich
    • 9
  • Devendra C. Desai
    • 3
  • Gopal Krishna Dhali
    • 10
  • Bhaba Dev Goswami
    • 11
  • Sanjeev K. Issar
    • 12
  • Ajay K. Jain
    • 13
  • Rakesh Kochhar
    • 7
  • Ajay Kumar
    • 14
  • Goundappa Loganathan
    • 15
  • Sri Prakash Misra
    • 16
  • C. Ganesh Pai
    • 17
  • Sujoy Pal
    • 2
  • Anna Pulimood
    • 1
  • Amarender S. Puri
    • 18
  • Ganesh N. Ramesh
    • 19
  • Gautam Ray
    • 20
  • Shivaram P. Singh
    • 21
  • Ajit Sood
    • 22
  • Manu Tandan
    • 23
  • for Indian Society of Gastroenterology Task Force on Inflammatory Bowel Diseases
  1. 1.Department of Gastrointestinal SciencesChristian Medical CollegeVelloreIndia
  2. 2.All India Institute of Medical SciencesNew DelhiIndia
  3. 3.P D Hinduja National Hospital and Medical Research CentreMumbaiIndia
  4. 4.Sanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia
  5. 5.Global Health CityChennaiIndia
  6. 6.Consultant GastroenterologistPatnaIndia
  7. 7.Postgraduate Institute of Medical Education and ResearchChandigarhIndia
  8. 8.Seth G S Medical College and K E M HospitalMumbaiIndia
  9. 9.S N Medical CollegeJodhpurIndia
  10. 10.Institute of Post Graduate Medical Education and ResearchKolkataIndia
  11. 11.Guwahati Medical CollegeGuwahatiIndia
  12. 12.Bhilai Steel Plant HospitalBhilaiIndia
  13. 13.Choithram Hospital and Research CentreIndoreIndia
  14. 14.Indraprastha Apollo HospitalNew DelhiIndia
  15. 15.G L HospitalSalemIndia
  16. 16.Moti Lal Nehru Medical CollegeAllahabadIndia
  17. 17.Kasturba Medical CollegeManipalIndia
  18. 18.G B Pant HospitalDelhiIndia
  19. 19.PVS Memorial HospitalKochiIndia
  20. 20.B R Singh Hospital Eastern RailwayKolkataIndia
  21. 21.S C B Medical CollegeCuttackIndia
  22. 22.Dayanand Medical College and HospitalLudhianaIndia
  23. 23.Asian Institute of GastroenterologyHyderabadIndia

Personalised recommendations