Sicilia Beatriz, García-López Santiago, González-Lama Yago, Zabana Yamile, Hinojosa Joaquín, Gomollón Fernando
Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital Universitario de Burgos, España.
Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Instituto de Investigaciones Sanitarias de Aragón, Zaragoza, España.
Gastroenterol Hepatol. 2020 Aug;43 Suppl 1:1-57. doi: 10.1016/j.gastrohep.2020.07.001.
Since the first edition of the Guidelines was published in 2013, much information has been generated around the treatment of ulcerative colitis, and new drugs and action protocols have been introduced. Clinical practice has changed substantially, warranting new approaches and a comprehensive review and update of the evidence.
Once again, we used the GRADE approach, supported by an electronic tool (https://gradepro.org). The clinical scenarios are the same as in the previous version (induction and maintenance in severe and mild-moderate flare-ups), as are the variables and their evaluation. However, in the updated guidelines, three questions have been deleted, 14 added and 30 maintained, making a total of 44 clinical questions. After an exhaustive review of the evidence, the recommendations are now updated.
Of the 44 questions analysed, no recommendation could be established in two due to the very low quality of the evidence, while in the other 42, based on different degrees of quality of evidence, recommendations were made according to the GRADE system. In 25 of these questions the final recommendation is strongly in favour, in six strongly against, in seven weakly in favour and in four weakly against. According to the scenarios and recommendations, six algorithms are proposed as a simple guide for practical decision-making.
The aim of this update of the 2013 guidelines is to provide answers, based on the GRADE approach, to the different questions we ask ourselves daily when deciding the most appropriate treatment for our patients with ulcerative colitis in the different clinical scenarios.
自《指南》第一版于2013年发布以来，围绕溃疡性结肠炎的治疗已产生了大量信息，并且引入了新药物和治疗方案。临床实践已发生了重大变化，需要新的方法以及对证据进行全面审查和更新。
在分析的44个问题中，由于证据质量极低，有2个问题无法给出推荐意见，而在其他42个问题中，根据不同程度的证据质量，按照GRADE系统给出了推荐意见。在这些问题中，25个问题的最终推荐意见强烈支持，6个强烈反对，7个微弱支持，4个微弱反对。根据临床场景和推荐意见，提出了6种算法作为实际决策的简单指南。
2013年指南此次更新的目的是基于GRADE方法，回答我们在为溃疡性结肠炎患者在不同临床场景中决定最合适治疗方案时每天都会问自己的不同问题。
