Medical management of left-sided ulcerative colitis and ulcerative proctitis: critical evaluation of therapeutic trials

Inflamm Bowel Dis. 2006 Oct;12(10):979-94. doi: 10.1097/01.mib.0000231495.92013.5e.


Background: The goal of this work was to critically evaluate the published studies on the treatment of ulcerative proctitis (UP) and left-sided ulcerative colitis (L-UC). The results of this review provided the content for the accompanying treatment guidelines, Clinical Guidelines for the Medical Management of Left-sided Ulcerative Colitis and Ulcerative Proctitis: Summary Statement.

Methods: All English language articles published between 1995 and September 2005 were identified through a comprehensive literature search using OVID and PubMed. The quality of the data supporting or rejecting the use of specific therapies was categorized by a data quality grading scale. An "A+" grade was assigned to treatment supported by multiple high-quality randomized controlled trials with consistent results, whereas a "D" grade was given to therapy supported only by expert opinion. The therapeutic efficacy of a treatment was defined by its success in treating UP and L-UC compared with placebo. A medication was ranked as "excellent" if it was specifically studied for UP and L-UC and had consistently positive results compared with placebo or another agent. Quality and efficacy scores were agreed on by author consensus.

Results: For the acute treatment of UP or L-UC, the rectally administered corticosteroids and mesalazine (5-ASA), either alone or in combination with oral 5-ASAs, are the most effective therapy: evidence quality, A+; efficacy, excellent. Only rectally administered 5-ASA received an A+/excellent rating for maintenance of remission. Infliximab received an A+ grade for induction and maintenance of remission but only a "good" rating because the studies were performed in all UC, not specifically UP or L-UC.

Conclusions: This critical evaluation of treatment provides a "report card" on medications available for the management of patients with UP and L-UC. The guidelines should provide a useful reference and supplement for physicians treating UC patients.

Publication types

  • Meta-Analysis

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage
  • Anti-Bacterial Agents / therapeutic use
  • Anti-Inflammatory Agents / administration & dosage
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage
  • Antibodies / therapeutic use
  • Clinical Trials as Topic* / methods
  • Colitis, Ulcerative / diagnosis
  • Colitis, Ulcerative / drug therapy
  • Colitis, Ulcerative / therapy*
  • Drug Administration Routes
  • Drug Therapy, Combination
  • Escherichia coli
  • Fatty Acids, Volatile / therapeutic use
  • Heparin / therapeutic use
  • Humans
  • Immunologic Factors / therapeutic use
  • Mesalamine / administration & dosage
  • Nicotine / therapeutic use
  • Probiotics / therapeutic use
  • Proctitis / diagnosis
  • Proctitis / drug therapy
  • Proctitis / therapy*
  • Remission Induction / methods
  • Research Design
  • Treatment Outcome


  • Adrenal Cortex Hormones
  • Anti-Bacterial Agents
  • Anti-Inflammatory Agents
  • Anti-Inflammatory Agents, Non-Steroidal
  • Antibodies
  • Fatty Acids, Volatile
  • Immunologic Factors
  • Mesalamine
  • Nicotine
  • Heparin