AGA Clinical Practice Guidelines on the Management of Moderate to Severe Ulcerative Colitis

Published:January 13, 2020DOI:
      This document presents the official recommendations of the American Gastroenterological Association (AGA) on the management of moderate to severe ulcerative colitis (UC). The guideline was developed by the AGA Institute’s Clinical Guidelines Committee and approved by the AGA Governing Board. It is accompanied by a technical review that provides a detailed synthesis of the evidence from which these recommendations were formulated.
      • Singh S.
      • Allegretti J.R.
      • Siddique S.M.
      • et al.
      AGA Technical review on the management of moderate to severe ulcerative colitis.
      Development of this guideline and the accompanying technical review was fully funded by the AGA Institute without additional outside funding. Members of the guideline panel and technical review panel were selected by the AGA Governing Board in consultation with the Clinical Guidelines Committee with careful consideration of all Institute of Medicine recommendations for clinical guideline development. Joseph Feuerstein was the guideline panel chair and Siddharth Singh was the methodologist and co-chair of the guideline panel. A patient representative was also included in the development and review process and had no recommended changes. The guideline and accompanying technical review underwent independent peer review, and a 30-day open public comment period; all comments were collated by the AGA staff, and were reviewed and carefully considered by the guideline panel and technical review teams, respectively. Changes were incorporated in revised documents, and where changes were not accepted, a thoughtful response document was created. After the public comment period, 2 pivotal clinical trials (VARSITY, UNIFI) were published and a critical safety update on tofacitinib was issued by the US Food and Drug Administration (FDA). At the recommendation of the Clinical Guidelines Committee, the technical review and clinical guidelines were updated to incorporate this new evidence as presented here. In accordance with the Clinical Guidelines Committee policies, all clinical guidelines are reviewed annually at the AGA Clinical Guideline Committee meeting for new information. The next update for these guidelines is anticipated in 3 years from publication.

      Abbreviations used in this paper:

      AGA (American Gastroenterological Association), 5-ASA (5-aminosalicylate), ASUC (acute severe ulcerative colitis), CI (confidence interval), FDA (US Food and Drug Administration), GRADE (Grading of Recommendations Assessment, Development and Evaluation), OR (odds ratio), RCT (randomized controlled trial), RR (relative risk), UC (ulcerative colitis)
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