Short updated German guideline on diagnosis and treatment of ulcerative colitis

Ulcerative colitis affects particularly young adults and therefore results in considerable direct and indirect health care costs. The update of the guideline aims at the improvement of both diagnostics and treatment. With regard to the differential diagnosis both the stool calprotectin level as well as intestinal ultrasound play an increasing role. Further, both at first diagnosis as well as at a severe flare one should look for infectious causes (particularly clostridium difficile- and cytomegalo virus infection). In order to minimize infections in patients with ulcerative colitis one should follow vaccination recommendations and recommendations prior to immunsuppressive therapy (which include steroids) (particularly tuberculosis and hepatitis B). Aminosalicylates can be used both during the acute flare and during maintenance therapy, however, with once daily intake leading to better treatment adherence. Treatment refractory flares can be treated with calcineurin antagonists or anti-TNF-α antibodies. Restorative proctocolectomy is a very good alternative treatment and should be discussed with the patient with severe colitis at an early point.