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4 Questions on the Updated ACG Guidelines for Managing UC
The American College of Gastroenterology (ACG) has issued an updated guideline for the management of adults with ulcerative colitis (UC) that includes recommendations on considering disease prognosis, recommendations on treating the hospitalized patient, new strategies for colon cancer screening, and more.
Gastroenterology Consultant caught up with David T. Rubin, MD, professor of medicine and section chief of Gastroenterology, Hepatology, and Nutrition at the University of Chicago, and lead author of the guidelines, on what gastroenterologists need to know about the guidelines.
Gastroenterology Consultant: How have the guidelines changed since the last update in 2010?
David Rubin: These guidelines were written with the clinician in mind. We wanted to make them practical, while thinking ahead and pushing the envelope so they wouldn’t be outdated the moment they were published. The guidelines not only reflect important changes in the field of gastroenterology, but also in the way guidelines are developed by the ACG. The ACG adopted an approach of grading the strengths of recommendations based on the available literature, and a more structured, systematic way to develop these guidelines. Our colleagues will find that this is very consistent with other guidelines released by the college in recent years.
There has also been a general shift in our understanding of the goal of managing UC. More specifically, we have now moved to understanding not just that the patient should feel better and have symptomatic improvement, but we have to heal the bowel and demonstrate objective evidence that the disease is under control. Another important update to the guidelines is the multiple new treatments available. There has also been an important shift in our general discussion about disease severity.
GASTRO CON: How do the guidelines incorporate disease activity and severity in UC management?
DR: What we’ve done is separate disease activity from disease severity. Prior to the updated guidelines, what we had said about choosing maintenance therapy was that a physician chooses a treatment based on how the patient is doing at that exact moment, and if it worked, then the patient would be committed to maintenance. However, it is more beneficial to the patient when a clinician considers prognosis when choosing therapy in the maintenance phase. Now we are saying maintenance therapy should be based on prognosis as well as a patient’s current disease activity. This is an important change.
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The American College of Gastroenterology (ACG) has issued an updated guideline for the management of adults with ulcerative colitis (UC) that includes recommendations on considering disease prognosis, recommendations on treating the hospitalized patient, new strategies for colon cancer screening, and more.
Gastroenterology Consultant caught up with David T. Rubin, MD, professor of medicine and section chief of Gastroenterology, Hepatology, and Nutrition at the University of Chicago, and lead author of the guidelines, on what gastroenterologists need to know about the guidelines.
Gastroenterology Consultant: How have the guidelines changed since the last update in 2010?
David Rubin: These guidelines were written with the clinician in mind. We wanted to make them practical, while thinking ahead and pushing the envelope so they wouldn’t be outdated the moment they were published. The guidelines not only reflect important changes in the field of gastroenterology, but also in the way guidelines are developed by the ACG. The ACG adopted an approach of grading the strengths of recommendations based on the available literature, and a more structured, systematic way to develop these guidelines. Our colleagues will find that this is very consistent with other guidelines released by the college in recent years.
There has also been a general shift in our understanding of the goal of managing UC. More specifically, we have now moved to understanding not just that the patient should feel better and have symptomatic improvement, but we have to heal the bowel and demonstrate objective evidence that the disease is under control. Another important update to the guidelines is the multiple new treatments available. There has also been an important shift in our general discussion about disease severity.
GASTRO CON: How do the guidelines incorporate disease activity and severity in UC management?
DR: What we’ve done is separate disease activity from disease severity. Prior to the updated guidelines, what we had said about choosing maintenance therapy was that a physician chooses a treatment based on how the patient is doing at that exact moment, and if it worked, then the patient would be committed to maintenance. However, it is more beneficial to the patient when a clinician considers prognosis when choosing therapy in the maintenance phase. Now we are saying maintenance therapy should be based on prognosis as well as a patient’s current disease activity. This is an important change.
