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Ulcerative colitis Learning Zone
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Ulcerative colitis overview

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Read time: 40 mins
Last updated:1st May 2024
Published:17th Aug 2023
In this section

Prevalence and burden of UC

Test your knowledge on ulcerative colitis

Challenge your knowledge by answering four questions in this short quiz on ulcerative colitis (UC). Your answers will also help us to measure the effectiveness of the medical education on Medthority.

Meet Jerome

Jerome, 33 years of age, presented to his GP with fatigue, bloody stools, diarrhoea and faecal incontinence, and was subsequently diagnosed with moderate-to-severe UC.

Test your knowledge on ulcerative colitis

Challenge your knowledge by answering four questions in this short quiz on ulcerative colitis (UC). Your answers will also help us to measure the effectiveness of the medical education on Medthority.

Meet Jerome

Jerome, 33 years of age, presented to his GP with fatigue, bloody stools, diarrhoea and faecal incontinence, and was subsequently diagnosed with moderate-to-severe UC.

1. Aside from corticosteroids, which of the following treatment options are recommended for inducing remission in moderate-to-severe UC, according to current European and US guidelines for UC management?
2. Jerome has asked for information about more recently approved UC treatments, such as the IL-23 inhibitor mirikizumab, JAK inhibitors upadacitinib and filgotinib, and the S1PR modulator ozanimod. In the clinical trials that supported regulatory approval of mirikizumab, upadacitinib, filgotinib and ozanimod for the treatment of moderate-to-severe UC in Europe and/or the US, the primary endpoint was:
3. What are key considerations that can inform whether recently approved biologics and targeted small molecules could be appropriate for Jerome (aside from disease severity and extent, and the regulatory-approved indications for each treatment)?
4. What is the primary aim of developing new treatments to help address unmet needs in moderate-to-severe and refractory UC?
How confident do you feel about managing a similar patient case?
Permission to contact. Please tick this box if you are willing for us to contact you at a later date to request more detailed feedback.

About UC

Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD) characterised by chronic inflammation in the gastrointestinal tract (GI)1, affecting the colon and rectum2. Both UC and another type of IBD, Crohn’s disease, are debilitating and chronic relapsing conditions1,3. In contrast to Crohn’s disease, which involves patchy lesions scattered throughout the GI tract and inflammation across all layers of the bowel wall, the inflammation in UC is usually restricted to the mucosal layer and causes superficial damage to the bowel wall2.

With a peak onset between 30 and 40 years of age, UC typically presents with bloody stools and diarrhoea, accompanied by urgency, faecal incontinence and fatigue4. Severe disease can present with fever and weight loss4.

The burden of gastrointestinal symptoms and faecal incontinence associated with UC can have a substantial impact on many aspects of patient quality of life (QoL)4

UC is associated with high morbidity and work disability5. Approximately 50% of people with UC will require UC-related hospitalisation during their disease course, and the 5- and 10-year cumulative risk of colectomy is 10–15%5.

Characterised by a relapsing and remitting course, UC involves alternating periods of flares and remissions2,6,7. The factors triggering flares are not fully understood, but may include environmental triggers, stress, diet and alterations in the gut microbiota2,6,7.

A diagnosis of UC is based on a combination of symptoms, findings from endoscopy and histology, and exclusion of other differential diagnoses and enteric infections4. UC is classified at diagnosis according to the extent and severity of disease8, which helps to inform subsequent treatment decisions9.

Prevalence of UC

Approximately 4.9 million cases of IBD were reported worldwide in 20193. Although IBD has been closely linked to a Westernised environment and lifestyle8, with highest prevalence in the USA and Europe8,10, IBD prevalence has been increasing in Asian countries, including China and Japan, over recent years3,11,12.

Worldwide, the incidence of UC is around 9–20 cases per 100,000 persons per year, with a prevalence of 156–291 cases per 100,000 persons per year8

In contrast to Crohn’s disease, UC is more prevalent in adults and less prevalent in the paediatric population8.

Burden of UC

The symptoms of UC can have an adverse impact on the daily life of patients, and reduce QoL4,13,14 across physical, sexual, psychological, and social domains4. An overview of the burden of UC on patients is shown in Figure 1.

Overview of the burden of ulcerative colitis and impacts on quality of lifeFigure 1. Overview of the burden of ulcerative colitis and impacts on quality of life4,5,15-18. UC, ulcerative colitis.

Physical burden of UC

The gastrointestinal symptoms, faecal incontinence and complications of UC can have a dramatic impact on QoL4. Particular IBD-related complications that can adversely impact patient QoL include chronic changes in bowel function, surgical scars and ostomy4.

Several studies have shown that UC has a significant impact on the quality of sexual life in both men and women4,16. Substantial problems with sexual functioning have been reported in those with active disease4,14.

The physical and clinical burden of UC can also vary according to disease severity and extent of disease13.

Higher morbidity rates, poorer health-related QoL, and difficulties in social and professional activities have been reported for people with moderate-to-severe UC, compared with the general population4

Acute UC flares have been associated with prolonged hospitalisation, and readmission of patients previously hospitalised for a UC flare has been associated with increased mortality19.

Colectomy is considered one of the most important adverse outcomes in people with UC20. Total proctocolectomy is still required in 15% of patients, particularly in those refractory to medications or who develop complications4. People with extensive or severe UC at diagnosis, or those with an early need for corticosteroids, are at higher risk of colectomy18.

Extra-intestinal manifestations and cancer risk add to the burden of UC15,18.

Psychosocial burden of UC

Patients with UC report limitations to their social interactions, activities and relationships because of the unpredictable nature of the disease4,14. People with UC can perceive a degree of social stigmatisation in response to their disruptive symptoms, which can lead to a desire for social withdrawal4.

Anxiety and depression are common in people with UC4. Findings of a cohort study indicate patients’ perception of their functional disability appear to be related to greater symptoms of anxiety and depression4. Fatigue, stress and sleep disorders have also been noted in people with UC4.

Dissatisfaction with body image is common in people with IBD, is associated with anxiety and depression, and is also linked to lower QoL, self-esteem and sexual satisfaction, leading to substantial psychological challenges4.

Overall, it is important to consider psychological comorbidities and their impact on the course of the disease in people with UC.

Socioeconomic burden of UC

In people with active UC, debilitating symptoms and poor control of bodily functions can impair daily activities, including employment and leisure activities4. Negative impacts of UC on work productivity include presenteeism, UC-related sick leave and absenteeism due to medical visits5,21.

The socioeconomic burden of UC also includes the cost of ongoing treatment and provision of healthcare services18,22,23.

There is an ongoing upward trajectory in global expenditure associated with the provision of healthcare services for people diagnosed with UC22,23

The escalating trend in disease-related expenditure can be attributed not only to increased prevalence of UC, but also the chronic nature of the disease, which necessitates long-term and, frequently, costly therapeutic interventions18,22,23.

A systematic review of 40 studies across the USA and Europe reported a high economic burden in people with moderate-to-severe UC starting treatment with biologics or small-molecule drugs18,22,23. This high economic burden was driven primarily by the cost of these treatments and outpatient visits associated with drug administration and monitoring18,22,23. However, biologic initiation was shown to reduce the indirect cost burden to these patients and improve QoL22. Aside from prescription costs increasing the total healthcare costs associated with biologic treatments, hospitalisation-related expenses were the main drivers of medical costs, followed by outpatient visits and emergency services’ costs22.

UC disease course and severity

Most patients experience a mild-to-moderate disease course at diagnosis, involving varied periods of remission or mild activity5. Approximately 10–15% of people with ulcerative colitis (UC) experience a more aggressive course of disease, with a cumulative risk of relapse of 70–80% at 10 years5.

While the extent of UC, severity of disease and prognosis are all key considerations that can influence treatment selection in UC9,15,24, disease extent can also inform decisions around the optimal route of drug administration25.

Extent of UC

The extent of disease in UC can be classified anatomically into the following groups, based on the Montreal classification26 (Figure 2).

  • Ulcerative proctitis – disease involvement is limited to the rectum
  • Left-sided UC (distal UC) – disease involvement is limited to a proportion of the colorectum distal to the splenic flexure
  • Extensive UC (pancolitis) – disease involvement extends proximal to the splenic flexure

Disease extent and rates of progression in patients with ulcerative colitis

Figure 2. Disease extent and rates of progression in patients with ulcerative colitis5,27. (Adapted27 under Creative Commons License CC BY 4.0). IQR, interquartile range; UC, ulcerative colitis. *Proportion of patients with the indicated extent of disease at diagnosis, according to a systematic review of population-based cohort studies in adults with ulcerative colitis (N=15,316). †Proportion of patients that progressed to the indicated extent of disease, with median follow-up ranging from 1–20 years.

Although most patients have left-sided colitis at diagnosis5, disease extent often changes over time5,26. Overall rates of progression in people with UC range from 12 to 30%, and the cumulative risk of progression over 5 years is approximately 13%5.

Severity of UC

An objective assessment of UC severity is key for guiding clinical management and predicting long-term outcomes in patients9

In particular, it is important to identify people with severe UC who need hospital admission, compared with those with mild or moderate activity who can be managed as outpatients28.

Tools to assess UC severity

The European Crohn’s and Colitis Organisation (ECCO) guidelines acknowledge that UC disease severity and activity can be measured according to several different definitions25, using a range of different instruments29.

The Truelove and Witts’ criteria30 are considered the best validated and most widely used index for identifying severe UC28,9, and modified versions of the original criteria from 1955 still inform management – particularly for identifying outpatients who require hospital admission and intensive treatment9,29

Modified criteria from Truelove and Witts are summarised in Table 1, according to the 2017 ECCO guidelines29.

Table 1. Disease activity in ulcerative colitis (Adapted29). Based on criteria modified from Truelove and Witts et al. 199530. bpm, beats per minute; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate.

Parameter Disease activity
  Mild Moderate
‘in between mild and severe’		 Severe
Bloody stools/day <4 4 or more, if ≥6, and
Pulse <90 bpm ≤90 bpm, or >90 bpm, or
Temperature <37.5 °C ≤37.8 °C, or >37.8 °C, or
Haemoglobin >11.5 g/dl ≥10.5 g/dl, or <10.5 g/dl, or
ESR <20 mm/h ≤30 mm/h, or >30 mm/h, or
CRP Normal ≤30 mg/l >30 mg/l

However, the Truelove and Witts’ criteria do not provide a quantitative or longitudinal measure of severity, and do not consider nocturnal symptoms, extra-intestinal manifestations or endoscopic severity9. Building upon Truelove and Witts’ original criteria, various other quantitative disease activity indices have been developed or proposed to address this gap. These include8,9:

  • The Montreal classification system8,24,26 – considers systemic illness or toxicity26, and is commonly used to evaluate extent and severity of disease8,24,29
  • The Mayo Clinic score9 – considers endoscopic findings and Physician’s Global Assessment score9
  • The Simple Clinical Colitis Activity Index – considers nocturnal bowel frequency, urgency of defecation, general wellbeing and extracolonic features9

The 2017 ECCO guidelines and 2019 consensus guidelines from the British Society of Gastroenterology support use of the Montreal classification system to guide UC severity assessment in UC29,24 (Table 2).

Table 2. Montreal classification of disease severity in ulcerative colitis29 (Adapted26,31). bpm, beats per minute; ESR, erythrocyte sedimentation rate. *The additional category of remission (SO) is defined as asymptomatic. †Minimal variation from normal, or no signs of systemic toxicity.

Parameter Disease activity*
  Mild (S1) Moderate (S2) Severe (S3)
Stools/day ≤4 >4 ≥6, and
Blood in stools May be present Present Present
Pulse Normal Minimal† >90 bpm, or
Temperature Normal Minimal† >37.5 °C, or
Haemoglobin Normal Minimal† <10.5 g/dL, or
ESR Normal Minimal† >30 mm/h

In addition, the updated 2019 American College of Gastroenterology guidelines proposed a UC activity index that incorporates both patient-reported outcomes and laboratory and endoscopy-based values9. It also includes an additional severity category for a type of rapid-onset progressive colitis known as fulminant9.

However, the 2020 guidelines from the American Gastroenterological Association use UC severity definitions based on Truelove and Witts’ criteria and the Mayo Clinic Score15.

Selecting the appropriate tool to assess UC severity

In practice, selection of the most appropriate disease severity scoring system for UC can be informed by the most recent version of local UC management guidelines in your region.

To improve care for people with UC, the ECCO guidelines note it is desirable to incorporate simple clinical and/or endoscopic scoring systems into assessments of disease severity and activity29.

Unmet needs in UC

Unmet needs and challenges in diagnosis and management of ulcerative colitis (UC) can impact provision of optimal care for people with UC. Join Dr Tim Raine, a gastroenterologist from Cambridge University Hospitals in the UK, for an overview.  

Key unmet needs and challenges in ulcerative colitis management and their impact

How can major unmet needs in UC impact treatment for people with moderate-to-severe UC? Professor Stephen Hanauer, a gastroenterologist from Northwestern University’s Feinberg School of Medicine, USA, provides an answer.

Key unmet needs and challenges in ulcerative colitis

Overall, these major unmet needs in UC management encompass challenges in diagnosis, risk stratification, treatment and communication between healthcare professionals and patients (Figure 3).

Major unmet needs in the management of ulcerative colitis

Figure 3. Major unmet needs in the management of ulcerative colitis14,28,32-36. UC, ulcerative colitis.

Addressing unmet needs in UC management

Earlier diagnosis and improved severity assessments

A reduced time to diagnosis and access to timely, effective treatments may help to improve outcomes for people with UC33. Indeed, extensive and/or severe disease activity at diagnosis has been associated with poor prognosis33.

Definitions of mild, moderate or severe UC have not been formally validated, and current severity scoring systems are based on historical definitions that are useful in distinguishing patients into disease categories likely to respond to various treatments36. An overall severity scoring system may help to move UC management from a reactive, disease-activity driven approach towards a more proactive approach36. Such an overall severity score could have implications for access to care and may connect point-in-time disease activity scoring systems with the identification of long-term high-risk disease characteristics36.

Limiting corticosteroid use in UC

Corticosteroid use in UC remains persistently high, despite the availability of biologic therapies35. Although corticosteroids can be effective for inducing remission, they are not effective at maintaining remission28.

Corticosteroids are not considered appropriate for long-term use, given the increased risk of adverse effects such as infections, osteoporosis, cataracts and myopathy28,37, which can outweigh their clinical benefits33

Improved treatment options to achieve and maintain remission

Although advances in UC treatment have led to an expanded range of therapeutic options for patients, remission and symptom reduction are still not achieved in a considerable proportion of patients1,38,39. There also remains a high incidence of primary and secondary response failure rate with currently available treatments40.

Despite biologic treatments being available for UC, more than 50% of people with moderate-to-severe UC do not achieve sustained remission40, and one in three patients with severe disease may still require life-changing colectomy4

Therefore, there is a need for more effective and targeted treatment options capable of inducing and maintaining remission in a larger proportion of patients1,33,38,39, including those with moderate-to-severe and refractory UC33,41. There is also a need for treatments that can modify the disease course and limit or prevent disease progression in people with UC32. Therapeutic options with a rapid onset of clinical effect would be particularly valued in moderate-to-severe UC33.

A lack of adherence to UC treatment has been reported in up to 72% of patients across various studies28,33,35,37, and has been associated with an increased risk for relapse40. Although many UC treatments are administered via injections or infusions, the availability of oral medications for UC1 may help to improve treatment adherence33,40.

Addressing unmet needs for improved treatment options in UC

To address unmet needs for achieving remission, limiting or avoiding surgery in people with severe disease and limiting corticosteroid use, numerous investigational biologics and small-molecule therapies are in development for UC1,28,42. These include investigational biologic and small-molecule therapies, with therapeutic targets including pro-inflammatory cytokines, cell adhesion molecules and various inflammatory pathways1.

Improved risk stratification

Risk stratification can be challenging when based on the clinical features of UC alone34. However, the identification of objective biomarkers may help to inform more precise treatment approaches for people with UC in the future34.

Individualised approaches to treatment selection

With heterogeneity in disease activity, presentation and disease course, there is substantial variation in treatment response among people with UC34,43. Determining which patients will benefit most from more intensive therapy remains a challenge34. Investigations are underway into potential biomarkers that may facilitate optimal treatment selection by predicting which patients are more likely to have treatment response or treatment-specific complications34,43.

Improved communication with patients

People with UC have expressed a need for improved information and communication with healthcare professionals about their disease, treatment options, emotional wellbeing, and their uncertainties and fears14. They also expressed a need for greater psychosocial guidance and support14.

Patient engagement is an important consideration in the management of UC, ensuring that individual preferences and uncertainties are considered and discussed, while encouraging shared decision-making14

UC pathophysiology and therapeutic targets

The pathophysiology of ulcerative colitis (UC) involves intestinal barrier dysfunction, a dysregulated immune response and altered gut microbiota, and is influenced by genetic and environmental factors2

An overview of UC pathophysiology is provided in Figure 4.

Pathophysiology of ulcerative colitis

Figure 4. Pathophysiology of ulcerative colitis (Adapted7,27 under Creative Commons CC BY 4.0 License). Disruption of tight junctions and the mucous layer increase permeability of the intestinal epithelium, leading to uptake of luminal antigens27. Antigen-presenting cells, such as dendritic cells, are activated by exposure to non-pathogenic, commensal bacteria27. This leads to release of pro-inflammatory cytokines, activation and differentiation of naive CD4+ T cells into Th2 effector cells, and production of more pro-inflammatory cytokines27. Entry of more T cells into the lamina propria is facilitated by binding of integrin-α4β7-bearing T cells to mucosal adhesion molecules (e.g., MAdCAM-1)27. Circulating leukocytes are also recruited via upregulation of inflammatory chemokines, perpetuating the inflammatory cycle27. DC, dendritic cell; IL, interleukin; MAdCAM-1, mucosal addressin cell adhesion molecule 1; NF-κB, nuclear factor kappa B; NKT, natural killer T cell; TGF-β, transforming growth factor-beta; Th, T helper; TLR, toll-like receptor; TNF-α, tumour necrosis factor-alpha; Treg, regulatory T cell.

Initially, UC is driven by disruption in the intestinal barrier2,27. This can arise from dysfunction in the epithelial cell layer or activation/production of inflammatory mediators and cells in the lamina propria2,27. The potential causes of barrier disruption include primary genetic defects, environmental factors such as changes to the microbiota, or altered expression of tight junction proteins2.

In UC, the disrupted epithelial barrier increases permeability of the intestinal lining to luminal antigens and pathogens, stimulating an inflammatory response and the release of pro-inflammatory mediators2,6, including tumour necrosis factor alpha (TNF-α), interleukin (IL)-12 and IL-23, and intracellular proteins, such as Janus kinases (JAK)6

Subsequently, this leads to infiltration of more immune cells, which exacerbates the inflammatory process and contributes to the chronicity of UC2.

UC can also involve dysregulation of the adaptive immune response via an imbalance between regulatory and effector T cells, which can disrupt the integrity of tight junctions6. Abnormal immune response in genetically susceptible individuals may also contribute to UC. Atypical T helper cells (Th), particularly Th2, can exert a cytotoxic response against epithelial cells in UC8.

Immune cells, such as T cells and B cells, and various cytokines play a crucial role in perpetuating the inflammatory process in UC. T cells release pro-inflammatory cytokines, such as TNF-α, IL-6 and IL-17, which further activate immune cells and perpetuate inflammation2,6,7.

However, the precise pathophysiology of UC is not yet fully elucidated2, and research is ongoing to further uncover the underlying mechanisms, to inform development of more effective treatments for the condition1,2,6.

Therapeutic targets in UC

  Advances in our understanding of UC pathophysiology have led to the development of new treatments2, and the therapeutic arsenal for UC is continuing to expand1. Many of the pro-inflammatory mediators involved in UC pathogenesis are targets for various current and investigational treatments for UC1,6. These targets include1:

  • Interleukins
  • TNF-α
  • Cell adhesion molecules
  • Other inflammatory pathways, such as sphingosine 1-phosphate receptor, Janus kinase, tyrosine kinase 2, and toll-like receptors

Pending results of further clinical trials, the development of investigational treatments may help to address major unmet needs in UC for achieving remission, reducing the requirement for surgery and limiting corticosteroid use, with the potential to improve outcomes and quality of life for people with UC1,28,42 .

More about current and investigational treatments for UC

References

  1. Zurba, 2023. Exploring the Pipeline of Novel Therapies for Inflammatory Bowel Disease; State of the Art Review. <link: https://www.doi.org/10.3390/biomedicines11030747 >
  2. Kobayashi, 2020. Ulcerative colitis. <link: https://www.doi.org/10.1038/s41572-020-0205-x >
  3. Wang, 2023. Global, regional and national burden of inflammatory bowel disease in 204 countries and territories from 1990 to 2019: a systematic analysis based on the Global Burden of Disease Study 2019. <link: https://www.doi.org/10.1136/bmjopen-2022-065186 >
  4. Armuzzi and Liguori, 2021. Quality of life in patients with moderate to severe ulcerative colitis and the impact of treatment: A narrative review. <link: https://www.doi.org/10.1016/j.dld.2021.03.002 >
  5. Fumery, 2018. Natural History of Adult Ulcerative Colitis in Population-based Cohorts: A Systematic Review. <link: https://www.doi.org/10.1016/j.cgh.2017.06.016 >
  6. Du and Ha, 2020. Epidemiology and Pathogenesis of Ulcerative Colitis. <link: https://www.doi.org/10.1016/j.gtc.2020.07.005 >
  7. Porter, 2020. Ulcerative colitis: Recent advances in the understanding of disease pathogenesis. <link: https://www.doi.org/10.12688/f1000research.20805.1 >
  8. Lynch and Hsu, 2023. Ulcerative colitis. https://www.ncbi.nlm.nih.gov/books/NBK459282/
  9. Rubin, 2019. ACG Clinical Guideline: Ulcerative Colitis in Adults. <link: https://www.doi.org/10.14309/ajg.0000000000000152 >
  10. Ng, 2017. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. <link: https://www.doi.org/10.1016/s0140-6736(17)32448-0 >
  11. Mak, 2020. The epidemiology of inflammatory bowel disease: East meets west. <link: https://www.doi.org/10.1111/jgh.14872 >
  12. Yamazaki, 2023. Trends in the prevalence and incidence of ulcerative colitis in Japan and the US. <link: https://www.doi.org/10.1007/s00384-023-04417-6 >
  13. Kemp, 2018. Second N-ECCO Consensus Statements on the European Nursing Roles in Caring for Patients with Crohn's Disease or Ulcerative Colitis. <link: https://www.doi.org/10.1093/ecco-jcc/jjy020 >
  14. Schoefs, 2023. What are the Unmet Needs and Most Relevant Treatment Outcomes According to Patients with Inflammatory Bowel Disease? A Qualitative Patient Preference Study. <link: https://www.doi.org/10.1093/ecco-jcc/jjac145 >
  15. Feuerstein, 2020. AGA Clinical Practice Guidelines on the Management of Moderate to Severe Ulcerative Colitis. <link: https://www.doi.org/10.1053/j.gastro.2020.01.006 >
  16. Leenhardt, 2019. Sexual health and fertility for individuals with inflammatory bowel disease. <link: https://www.doi.org/10.3748/wjg.v25.i36.5423 >
  17. Santiago, 2020. Rehospitalization rates, costs, and risk factors for inflammatory bowel disease: a 16-year nationwide study. <link: https://www.doi.org/10.1177/1756284820923836 >
  18. Zhao, 2021. The Burden of Inflammatory Bowel Disease in Europe in 2020. <link: https://www.doi.org/10.1093/ecco-jcc/jjab029 >
  19. Weissman, 2021. Increased Mortality and Healthcare Costs Upon Hospital Readmissions of Ulcerative Colitis Flares: A Large Population-Based Cohort Study. <link: https://www.doi.org/10.1093/crocol/otab029 >
  20. Parragi, 2018. Colectomy Rates in Ulcerative Colitis are Low and Decreasing: 10-year Follow-up Data From the Swiss IBD Cohort Study. <link: https://www.doi.org/10.1093/ecco-jcc/jjy040 >
  21. Barreiro-de Acosta, 2023. Epidemiological, Clinical, Patient-Reported and Economic Burden of Inflammatory Bowel Disease (Ulcerative colitis and Crohn's disease) in Spain: A Systematic Review. <link: https://www.doi.org/10.1007/s12325-023-02473-6 >
  22. Cichewicz, 2023. A Systematic Review of the Economic and Health-Related Quality of Life Impact of Advanced Therapies Used to Treat Moderate-to-Severe Ulcerative Colitis. <link: https://www.doi.org/10.1007/s12325-023-02488-z >
  23. van Linschoten, 2021. Systematic review: societal cost of illness of inflammatory bowel disease is increasing due to biologics and varies between continents. <link: https://www.doi.org/10.1111/apt.16445 >
  24. Lamb, 2019. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. <link: https://www.doi.org/10.1136/gutjnl-2019-318484 >
  25. Raine, 2022. ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment. <link: https://www.doi.org/10.1093/ecco-jcc/jjab178 >
  26. Satsangi, 2006. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. <link: https://www.doi.org/10.1136/gut.2005.082909 >
  27. Yeshi, 2020. Revisiting Inflammatory Bowel Disease: Pathology, Treatments, Challenges and Emerging Therapeutics Including Drug Leads from Natural Products. <link: https://www.doi.org/10.3390/jcm9051273 >
  28. Salice, 2019. A current overview of corticosteroid use in active ulcerative colitis. <link: https://www.doi.org/10.1080/17474124.2019.1604219 >
  29. Magro, 2017. Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-intestinal Manifestations, Pregnancy, Cancer Surveillance, Surgery, and Ileo-anal Pouch Disorders. <link: https://www.doi.org/10.1093/ecco-jcc/jjx008 >
  30. Truelove and Witts, 1955. Cortisone in ulcerative colitis; final report on a therapeutic trial. <link: https://www.doi.org/10.1136/bmj.2.4947.1041 >
  31. Silverberg, 2005. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. <link: https://www.doi.org/10.1155/2005/269076 >
  32. Burisch, 2019. Natural Disease Course of Ulcerative Colitis During the First Five Years of Follow-up in a European Population-based Inception Cohort-An Epi-IBD Study. <link: https://www.doi.org/10.1093/ecco-jcc/jjy154 >
  33. Danese, 2019. Unmet Medical Needs in Ulcerative Colitis: An Expert Group Consensus. <link: https://www.doi.org/10.1159/000496739 >
  34. Reves, 2021. Unmet needs in inflammatory bowel disease. <link: https://www.doi.org/10.1016/j.crphar.2021.100070 >
  35. Targownik, 2021. Trends in Corticosteroid Use During the Era of Biologic Therapy: A Population-Based Analysis. <link: https://www.doi.org/10.14309/ajg.0000000000001220 >
  36. Pabla and Schwartz, 2020. Assessing Severity of Disease in Patients with Ulcerative Colitis. <link: https://www.doi.org/10.1016/j.gtc.2020.08.003 >
  37. Travis, 2008. How do you avoid and treat steroid side effects? <link: https://www.doi.org/10.1002/ibd.20649 >
  38. Lindsay, 2023. The incidence of remission and indicators of inadequate response to advanced therapy in patients with ulcerative colitis: results from medical charts in the United Kingdom. <link: https://www.doi.org/10.1080/03007995.2023.2194782 >
  39. Wei, 2021. Epidemiology, burden of disease, and unmet needs in the treatment of ulcerative colitis in Asia. <link: https://www.doi.org/10.1080/17474124.2021.1840976 >
  40. Goetsch, 2023. Advances in pharmacotherapy for ulcerative colitis: a focus on JAK1 inhibitors. <link: https://www.doi.org/10.1080/14656566.2023.2200931 >
  41. Saiki, 2021. Treatment-refractory ulcerative colitis responsive to indigo naturalis. <link: https://www.doi.org/10.1136/bmjgast-2021-000813 >
  42. Rubin, 2017. Communication Between Physicians and Patients with Ulcerative Colitis: Reflections and Insights from a Qualitative Study of In-Office Patient-Physician Visits. <link: https://www.doi.org/10.1097/MIB.0000000000001048 >
  43. Lenti, 2023. Personalize, participate, predict, and prevent: 4Ps in inflammatory bowel disease. <link: https://www.doi.org/10.3389/fmed.2023.1031998 >
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