Steroid-refractory ulcerative colitis: a critical review of national and international guideline recommendations

Zusammenfassung

Es gibt zahlreiche nationale und internationale Leitlinien zu chronisch entzündlichen Darmerkrankungen, die auf vergleichbarer Evidenz sowie ähnlichen Prozeduren beruhen und daher homogen sein sollten. In dieser kritischen Übersicht wurden die Leitlinienempfehlungen aus Europa (ECCO), Deutschland, Großbritannien, Kanada, den USA und Japan zur Therapie der steroidrefraktären Colitis ulcerosa verglichen. Die meisten Leitlinien unterschieden zwischen moderater/schwerer (ambulanter) und schwerer/fulminanter Colitis in der Klinik. Die Empfehlungen zur ersten Kategorie weisen gravierende Unterschiede auf, während zur Behandlung des stationären Patienten weitgehende Übereinstimmung herrscht. Verschiedene Erklärungen für die Inkonsistenzen werden diskutiert.

Abstract

There is a multitude of national and international guidelines in the IBD sector, all of which are based on similar evidence as well as similar consensus procedures and therefore should be rather homogeneous. This critical review was undertaken to compare the guideline recommendations from Europe (ECCO), Germany, the United Kingdom, Canada, the USA, and Japan in the specific clinical area of how to treat steroid-refractory ulcerative colitis. Most but not all of the guidelines were structured into a part covering moderate/severe outpatient colitis and another section dealing with severe, sometimes fulminant inpatient disease. The recommendations in the first part display major discrepancies whereas there is largely agreement in the inpatient situation. Overall, national and international guidelines lack consistency. Reasons for these discrepancies are discussed.

Schlüsselwörter

Colitis ulcerosa - steriod-refraktär - Leitlinien

Keywords

Ulcerative colitis - steroid-refractory - guidelines

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