Segundo Consenso Brasileiro no manejo da retocolite ulcerativa em adultos: um consenso da Organização Brasileira para Doença de Crohn e Colite (GEDIIB)

BAIMA, Júlio Pinheiro; IMBRIZI, Marcello; ANDRADE, Adriana Ribas; CHEBLI, Liliane Andrade; ARGOLLO, Marjorie Costa; QUEIROZ, Natália Sousa Freitas; AZEVEDO, Matheus Freitas Cardoso de; VIEIRA, Andrea; COSTA, Marcia Henriques de Magalhães; FRÓES, Renata de Sá Brito; PENNA, Francisco Guilherme Cancela e; QUARESMA, Abel Botelho; DAMIÃO, Aderson Omar Mourão Cintra; MORAES, Antonio Carlos da Silva; SANTOS, Carlos Henrique Marques dos; FLORES, Cristina; ZALTMAN, Cyrla; VILELA, Eduardo Garcia; MORSOLETTO, Eloá; GONÇALVES FILHO, Francisco de Assis; SANTANA, Genoile Oliveira; ZABOT, Gilmara Pandolfo; PARENTE, José Miguel Luz; SASSAKI, Ligia Yukie; ZERÔNCIO, Marco Antonio; MACHADO, Marta Brenner; CASSOL, Ornella Sari; KOTZE, Paulo Gustavo; PARRA, Rogerio Serafim; MISZPUTEN, Sender Jankiel; COY, Cláudio Saddy Rodrigues; AMBROGINI JUNIOR, Orlando; CHEBLI, Júlio Maria Fonseca; SAAD-HOSSNE, Rogério

Júlio Pinheiro BAIMA

methodology

literature review

recommendations decision making

writing and review

Universidade Nove de Julho, Bauru, SP, Brasil.

Hospital das Clínicas da Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil.

http://orcid.org/0000-0002-4035-3113

Marcello IMBRIZI

methodology

literature review

recommendations decision making

writing and review

Universidade Estadual de Campinas, Campinas, SP, Brasil.

http://orcid.org/0000-0001-5397-0084

Adriana Ribas ANDRADE

methodology

literature review

recommendations decision making

writing and review

Universidade Estadual da Bahia, Salvador, BA, Brasil.

http://orcid.org/0000-0001-6012-2155

Liliane Andrade CHEBLI

methodology

literature review

recommendations decision making

writing and review

Universidade federal de Juiz de Fora, Juiz de Fora, MG, Brasil.

http://orcid.org/0000-0002-7875-1475

Marjorie Costa ARGOLLO

methodology

literature review

recommendations decision making

writing and review

Universidade Federal de São Paulo, São Paulo, SP, Brasil.

http://orcid.org/0000-0001-9867-8861

Natália Sousa Freitas QUEIROZ

methodology

literature review

recommendations decision making

writing and review

Hospital Santa Cruz, Curitiba, PR, Brasil.

http://orcid.org/0000-0003-2857-0825

Matheus Freitas Cardoso de AZEVEDO

methodology

literature review

recommendations decision making

writing and review

Universidade Estadual de São Paulo, São Paulo, SP, Brasil.

http://orcid.org/0000-0001-5487-9418

Andrea VIEIRA

methodology

literature review

recommendations decision making

writing and review

Irmandade Santa Casa de Misericórdia de São Paulo, SP, Brasil.

http://orcid.org/0000-0003-1858-3446

Marcia Henriques de Magalhães COSTA

methodology

literature review

recommendations decision making

writing and review

Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Rio de Janeiro, RJ, Brasil.

http://orcid.org/0000-0002-5636-7501

Renata de Sá Brito FRÓES

methodology

literature review

recommendations decision making

writing and review

Gastromed, São Paulo, SP, Brasil.

http://orcid.org/0000-0003-3256-4698

Francisco Guilherme Cancela e PENNA

methodology

literature review

recommendations decision making

writing and review

Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.

http://orcid.org/0000-0002-2338-5367

Abel Botelho QUARESMA

recommendations decision making

Universidade do Oeste de Santa Catarina, Joaçaba, SC, Brasil.

http://orcid.org/0000-0002-3985-7402

Aderson Omar Mourão Cintra DAMIÃO

recommendations decision making

Universidade Estadual de São Paulo, São Paulo, SP, Brasil.

http://orcid.org/0000-0001-7584-7351

Antonio Carlos da Silva MORAES

recommendations decision making

Hospital Copa D’Or, São Paulo, SP, Brasil.

http://orcid.org/0000-0002-5533-5401

Carlos Henrique Marques dos SANTOS

recommendations decision making

Hospital Universitário Maria Aparecida Pedrossian, Campo Grande, MS, Brasil.

http://orcid.org/0000-0002-1181-7329

Cristina FLORES

recommendations decision making

Centro de Referência em Crohn e Colite do Rio Grande do Sul, Porto Alegre, RS, Brasil.

http://orcid.org/0000-0003-1623-4525

Cyrla ZALTMAN

recommendations decision making

Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.

http://orcid.org/0000-0002-5236-6501

Eduardo Garcia VILELA

recommendations decision making

Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.

http://orcid.org/0000-0002-5443-7553

Eloá MORSOLETTO

recommendations decision making

Hospital São Vicente, Curitiba, PR, Brasil.

http://orcid.org/0000-0001-9204-2651

Francisco de Assis GONÇALVES FILHO

recommendations decision making

Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brasil.

http://orcid.org/0000-0003-0153-4349

Genoile Oliveira SANTANA

recommendations decision making

Universidade Estadual da Bahia, Salvador, BA, Brasil.

http://orcid.org/0000-0001-5936-9791

Gilmara Pandolfo ZABOT

recommendations decision making

Hospital Moinhos de Vento e Coloprocto Clínica do Aparelho Digestivo, Porto Alegre, RS, Brasil.

http://orcid.org/0000-0002-1253-4945

José Miguel Luz PARENTE

recommendations decision making

Universidade Federal do Piauí, Teresina, PI, Brasil.

http://orcid.org/0000-0003-4563-2784

Ligia Yukie SASSAKI

recommendations decision making

Universidade Estadual de São Paulo, Botucatu, SP, Brasil.

http://orcid.org/0000-0002-7319-8906

Marco Antonio ZERÔNCIO

recommendations decision making

Promater - Hospital Geral, Natal, RN, Brasil.

http://orcid.org/0000-0002-1006-1101

Marta Brenner MACHADO

recommendations decision making

Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil.

http://orcid.org/0000-0003-2266-2542

Ornella Sari CASSOL

recommendations decision making

Hospital de Clínicas de Passo Fundo, Passo Fundo, RS, Brasil.

http://orcid.org/0000-0003-0867-6593

Paulo Gustavo KOTZE

final review of the manuscript

Pontifícia Universidade Católica do Paraná, Programa de Pós-Graduação em Ciências da Saúde, Curitiba, PR, Brasil.

http://orcid.org/0000-0002-2053-5315

Rogerio Serafim PARRA

recommendations decision making

Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.

http://orcid.org/0000-0002-5566-9284

Sender Jankiel MISZPUTEN

recommendations decision making

Professor Aposentado da UNIFESP, São Paulo, SP, Brasil.

http://orcid.org/0000-0003-4487-5004

Cláudio Saddy Rodrigues COY

final review of the manuscript

Universidade Estadual de Campinas, Campinas, SP, Brasil.

http://orcid.org/0000-0002-0916-4138

Orlando AMBROGINI JUNIOR

final review of the manuscript

Universidade Federal de São Paulo, São Paulo, SP, Brasil.

http://orcid.org/0000-0003-3318-6246

Júlio Maria Fonseca CHEBLI

methodology

literature review

recommendations decision making

writing and review

Universidade federal de Juiz de Fora, Juiz de Fora, MG, Brasil.

http://orcid.org/0000-0003-1527-0663

Rogério SAAD-HOSSNE

Universidade Estadual de São Paulo, Botucatu, SP, Brasil.

http://orcid.org/0000-0002-8166-0304

Corresponding author: Marcello Imbrizi. E-mail: marcelloimbrizi@gmail.com

Conflict of interest: the authors receive support for conferences, lectures, or clinical research at the aforementioned laboratories. Abel Botelho Quaresma: AbbVie, Apsen, Janssen; Gilmara Pandolfo Zabot: Abbvie, Takeda, Janssen; Júlio Pinheiro Baima: Janssen, Takeda, Pfizer; Marcello Imbrizi: Abbvie, Takeda, Janssen; Ornella Sari Cassol: Janssen, Abbvie, Takeda, Nestle, Buhlmann; Paulo Gustavo Kotze: Abbvie, Takeda, Pfizer, Janssen; Rogerio Serafim Parra: Takeda, Pfizer, Janssen; Matheus Freitas Cardoso de Azevedo: Janssen, Takeda, Pfizer, Abbvie; Natália Souza Freitas Queiroz: Abbvie, Takeda, Janssen; Júlio Maria Fonseca Chebli: Abbott, Abbivie, Jansen, Takeda; Liliane Andrade Chebli: Jansen, Takeda; Marjorie Costa Argollo: Janssen, Takeda, Pfizer, Abbvie, Sandoz; Ligia Yukie Sassaki: Janssen, Takeda; Adérson Omar Mourão Cintra Damião: Janssen, Takeda, Abbvie, Ferring; Antonio Carlos da Silva Moraes: Abbvie, Takeda, Jansen, FQM, Pfizer; Cristina Flores: Takeda, Janssen, Pfizer, Abbvie; Cyrla Zaltman: Takeda, Abbvie, Janssen, Pfizer, Ferring; Eduardo Garcia Vilela: Ferring; Eloá Morsoletto: Takeda, Janssen; Francisco de Assis Gonçalves Filho: Takeda, Janssen; Francisco Guilherme Cancela e Penna: Abbvie, Janssen, Novartis, Takeda; Genoile Oliveira Santana: Abbvie, Ferring, Janssen, Pfizer, Takeda; José Miguel Luz Parente: Abbvie, Janssen, Takeda, Pfizer ; Marcia Henriques de Magalhães Costa: Janssen, Abbvie, Takeda, Pfizer ; Marco Antonio Zerôncio: Takeda, Janssen, Abbvie; Marta Brenner Machado: Janssen, Abbvie, Takeda , Ferring, Pfizer; Renata de Sá Brito Fróes: Janssen, Takeda, Abbvie, Pfizer; Orlando Ambrogini Junior: Abbvie, Janssen, Pfizer, Takeda; Carlos Henrique Marques dos Santos: Abbvie, Takeda, Janssen; Rogério Saad-Hossne: Abbvie, Takeda, Janssen, Pfizer, Sandoz

Universidade Nove de Julho, Bauru, SP, Brasil.

Hospital das Clínicas da Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil.

Universidade Estadual de Campinas, Campinas, SP, Brasil.

Universidade Estadual da Bahia, Salvador, BA, Brasil.

Universidade federal de Juiz de Fora, Juiz de Fora, MG, Brasil.

Universidade Federal de São Paulo, São Paulo, SP, Brasil.

Hospital Santa Cruz, Curitiba, PR, Brasil.

Universidade Estadual de São Paulo, São Paulo, SP, Brasil.

Irmandade Santa Casa de Misericórdia de São Paulo, SP, Brasil.

Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Rio de Janeiro, RJ, Brasil.

Gastromed, São Paulo, SP, Brasil.

Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.

Universidade do Oeste de Santa Catarina, Joaçaba, SC, Brasil.

Hospital Copa D’Or, São Paulo, SP, Brasil.

Hospital Universitário Maria Aparecida Pedrossian, Campo Grande, MS, Brasil.

Centro de Referência em Crohn e Colite do Rio Grande do Sul, Porto Alegre, RS, Brasil.

Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.

Hospital São Vicente, Curitiba, PR, Brasil.

Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brasil.

Hospital Moinhos de Vento e Coloprocto Clínica do Aparelho Digestivo, Porto Alegre, RS, Brasil.

Universidade Federal do Piauí, Teresina, PI, Brasil.

Universidade Estadual de São Paulo, Botucatu, SP, Brasil.

Promater - Hospital Geral, Natal, RN, Brasil.

Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil.

Hospital de Clínicas de Passo Fundo, Passo Fundo, RS, Brasil.

Pontifícia Universidade Católica do Paraná, Programa de Pós-Graduação em Ciências da Saúde, Curitiba, PR, Brasil.

Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.

Professor Aposentado da UNIFESP, São Paulo, SP, Brasil.

	Remission	Mild	Moderate-severe	Fulminant
Stools (#/d)	Formed stools	<4	>6	>10
Blood in stools	None	Intermittent	Frequent	Continuous
Urgency	None	Mild, occasional	Often	Continuous
Hemoglobin	Normal	Normal	<75%	Transfusion required
ESR	<30	<30	>30	>30
CRP (mg/mL)	Normal	Elevated	Elevated	Elevated
FC (µg/mL)	<150-200	>150-200	>150-200	>150-200
Endoscopy (Mayo subscore)	0-1	1	2-3	3
UCEIS	0-1	2-4	5-8	7-8

Mayo Index	0	1	2	3
Stool frequency	Normal	1-2 / day more than normal	3-4 / day more than normal	5 / day more than normal
Rectal bleeding	None	Streaks of blood with stool <50% of the time	Obvious blood with stool most of time	Blood passed without stool
Mucosa (endoscopic subscore)	Normal or inactive disease	Mild disease (erythema, decreased vascular pattern, mild friability)	Moderate disease (marked erythema, lack of vascular pattern, friability, erosions)	Severe disease (spontaneous bleeding, ulceration)
Physician’s global assessment	Normal	Mild disease	Moderate disease	Severe disease

Descriptor (score most severe lesions)	Likert scale	Definition
Vascular pattern*	Normal (1)	Normal vascular pattern with arborization of capillaries clearly defined, or with blurring or patchy loss of capillary margins
	Patchy obliteration (2)	Patchy obliteration of vascular pattern
	Obliterated (3)	Complete obliteration of vascular pattern
Bleeding*	None (1)	No visible blood
	Mucosal (2)	Some spots or streaks of coagulated blood on the surface of the mucosa ahead of the scope that can be washed away
	Luminal mild (3)	Some free liquid blood in the lumen
	Luminal moderate or severe (4)	Frank blood in the lumen ahead of endoscope or visible oozing from mucosa after washing intraluminal blood or visible oozing from a hemorrhagic mucosa
Erosions and ulcers*	None (1)	Normal mucosa and no visible erosions or ulcers
	Erosions (2)	Tiny (≤5 mm) mucosa defects of a white or yellow color with a flat edge
	Superficial ulcer (3)	Larger (>5 mm) defects in the mucosa that are discrete fibrin-covered ulcers when compared with erosions, but remain superficial
	Deep ulcer (4)	Deeper excavated defects in the mucosa, with a slightly raised edge

mMS subscores by category
Stool frequency*
0	Normal number of stools
1	1-2 more stools than usual
2	3-4 more stools than usual
3	5 or more stools than usual
Rectal bleeding**
0	No blood seen
1	Stool with streaks of blood
2	Stool with more than streaks of blood
3	Blood alone passed
Endoscopy
0	Normal appearance of mucosa
1	Mild disease (erythema, decreased vascular pattern), no friability
2	Moderate disease (marked erythema, absent vascular pattern, friability, erosions)
3	Severe disease (spontaneous bleeding, ulcerations)

Drug	Induction dose	Maintenance dose
5-ASA	Topical: mesalazine suppositories: 500 mg to 1 g/day	Topical: Mesalazine suppositories 500 mg to 1g 3 times per week
	Mesalazine enema: 1-3 g/day	Oral: Mesalazine (granules or tablets) or sulfasalazine ≥2 g/day
	Oral: mesalazine (granules or tablets) or sulfasalazine ≥ 3 g/day
Corticosteroids	Budesonide MMX: 9 mg/day for 2-3 months.	Maintenance dose is not indicated. For prednisolone use, after 14 days of full dose, if patient with clinical improvement, consider tapering at 5 mg/week over an 8-to 12-week period
	Prednisolone: 0.50 to 0.75 mg/kg PO with a maximum daily dose of 60 mg
Cyclosporine	Intravenous cyclosporine (50 mg/mL)	Oral cyclosporine (25 mg, 50 mg or 100 mg capsules 100 mg/mL solution) 5 mg/kg/day for up to 3 months
	2 mg/kg/day (with serum drug monitoring)
Immunosuppressants	Thiopurines: Azathioprine 1.5-2.5 mg/kg/day PO	Thiopurines: Azathioprine 1,5-2,5 mg/kg/day PO
	6-mercaptopurine (6-MP): 1-1.5 mg/kg/day PO	6-mercaptopurine (6-MP): 1-1.5 mg/kg/day PO
Anti-TNF	Infliximab 10 mg/mL (10 mL/unit): 5 mg/kg IV at 0, 2, and 6 weeks or infliximab 5 mg/kg IV at 0 and 2 weeks	Infliximab 10 mg/mL (10mL/unit): 5 mg/kg IV every 8 weeks or Infliximab 120mg SC every 2 weeks from week 6
	Adalimumab 40 mg (syringe or pen) or 80 mg (pen): 160 mg SC and then 80 mg after 2 weeks	Optimized dose: 10 mg/kg IV every 8 weeks or 5 mg/kg IV every 4 weeks
	Golimumab 50 mg, 100 mg or 200 mg/dose (pen): 200 mg SC and then 100 mg SC after 2 weeks	Adalimumab 40 mg (syringe or pen) or 80 mg (pen): 40 mg SC every 2 weeks
		Optimized dose: 40 mg SC weekly or 80 mg SC every 2 weeks
		Golimumab 50 mg, 100 mg: 50 to 100 mg every 4 weeks
Anti-integrin	Vedolizumab 300 mg/unit	Vedolizumab 300 mg/unit: 300 mg IV every 8 weeks (vedolizumab): or 108 mg SC every 2 weeks starting after the second or third IV induction dose
	300 mg IV at weeks 0, 2 and 6	Optimized dose: 300 mg IV every 4 weeks or 108 mg SC weekly (off label)
Anti-interleukin	Ustekinumab 130 mg/ 26 mL or 90 mg/unit: 55 kg or less: 260 mg IV	Ustekinumab 90 mg/unit: 90 mg SC every 8 or 12 weeks Optimized dose: 90 mg SC every 4 weeks (off-label)
	55 kg to 85 kg: 390 mg IV
	more than 85 kg: 520 mg IV
Jak inhibitors	Tofacinitib 5 mg and 10 mg	Tofacinitib 5 mg
	10 mg bid PO for 8 to 12 weeks	5 mg PO BID
	Upadacitinib*: 45 mg PO once a day for 8 weeks	*if loss of response, consider new induction period for 8 weeks
	Filgotinib**: 200 mg PO once a day for 10 weeks	Upadacitinib*: 15 mg once a day
		Refractory, severe, or extensive disease: consider 30 mg q day
		Filgotinib**: 100 mg to 200 mg PO once a day
Sphingosine-1-phosphate (S1P) receptor modulator	Ozanimod 0.92 mg*: day 1-4: 0.23 mg PO q day	Ozanimod 0.92 mg*: day 8 and thereafter: 0.92 mg PO q day
	Days 5-7: 0.46 mg PO q say

study design	Search strategy	Results (titles)
Guidelines or consensus	((“inflammatory bowel disease”[Title] OR “IBD”[Title] OR “ulcerative colitis”[Title]) AND (“treatment”[Title/Abstract] OR “management”[Title/Abstract] OR “monitoring”[Title/Abstract]) AND (“consensus”[Title] OR “guidelines”[Title]) AND “English”[Language])) AND ((y_5[Filter]) AND (english[Filter]))	81
Systematic literature reviews with meta-analysis	((“inflammatory bowel disease”[Title] OR “IBD”[Title] OR “ulcerative colitis”[Title]) AND (“treatment”[Title/Abstract] OR “management”[Title/Abstract] OR “monitoring”[Title/Abstract]) AND (“meta-analysis”[Publication Type] AND “English”[Language])) AND ((meta-analysis[Filter]) AND (english[Filter]))	301

Authors, year	Title	Domain 1 score	Domain 2 score	Domain 3 score	Domain 4 score	Domain 5 score	Domain 6 score	Overall assessment
Abdulrazeg et al., 2019	Management of ulcerative colitis: summary of updated NICE guidance.	66.7	38.9	39.6	66.7	29.2	33.3	45.7
Amiot et al., 2021	Clinical guidelines for managing inflammatory bowel disease: update of a French National Consensus.	16.7	55.6	35.4	38.9	41.7	50.0	39.7
Bonnaud et al., 2020	Monitoring of inflammatory bowel disease in 2019: A French consensus for clinical practice.	61.1	72.2	45.8	77.8	58.3	58.3	62.3
Cheifetz et al., 2021	A Comprehensive Literature Review and Expert Consensus Statement on therapeutic drug monitoring of biologics in inflammatory bowel disease.	100.0	88.9	62.5	88.9	62.5	75.0	79.6
Choi et al., 2017	Second Korean guidelines for the management of ulcerative colitis.	72.2	38.9	68.8	77.8	37.5	58.3	58.9
Feuerstein et al., 2021	AGA clinical practice guidelines on the medical management of moderate-to-severe luminal and perianal fistulizing Crohn’s disease.	94.4	72.2	58.3	83.3	20.8	100.0	71.5
Greuter et al., 2020	Therapeutic drug monitoring to guide clinical decision making in inflammatory bowel disease patients with loss of response to anti-TNF: A Delphi Technique-Based Consensus.	72.2	61.1	47.9	83.3	54.2	83.3	67.0
Harbord et al., 2017	Third European Evidence-based Consensus on diagnosis and management of ulcerative colitis. Part 2: current management.	77.8	61.1	70.8	88.9	62.5	83.3	74.1
Ko et al., 2019	AGA Clinical Practice Guidelines on the management of mild-to-moderate ulcerative colitis.	88.9	55.6	41.7	61.1	45.8	41.7	55.8
Lamb et al., 2019	British Society of Gastroenterology Consensus Guidelines on the management of inflammatory bowel disease in adults.	100.0	100.0	100.0	100.0	95.8	100.0	99.3
Maaser et al., 2019	ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1: initial diagnosis, monitoring of known IBD, detection of complications.	100.0	100.0	75.0	83.3	58.3	83.3	83.3
Magro et al., 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.	77.8	61.1	70.8	88.9	62.5	83.3	74.1
Matsuoka et al., 2018	Evidence-based clinical practice guidelines for inflammatory bowel disease.	83.3	61.1	66.7	83.3	50.0	66.7	68.5
Nakase et al., 2021	Evidence-based clinical practice guidelines for inflammatory bowel disease 2020.	83.3	72.2	81.3	83.3	50.0	66.7	72.8
Papamichael et al., 2019	Appropriate therapeutic drug monitoring of biologic agents for patients with inflammatory bowel diseases.	83.3	72.2	60.4	77.8	58.3	58.3	68.4
Qian et al., 2021	Chinese consensus on diagnosis and treatment in inflammatory bowel disease (2018, Beijing).	72.2	61.1	56.3	50.0	41.7	50.0	55.2
Raine et al., 2021	ECCO Guidelines on therapeutics in ulcerative colitis: medical treatment.	100.0	100.0	75.0	83.3	58.3	83.3	83.3
Rubin et al., 2019	ACG Clinical Guideline: ulcerative colitis in adults.	72.2	61.1	45.8	72.2	41.7	66.7	60.0
Syal et al., 2021	Health Maintenance Consensus for adults with inflammatory bowel disease.	66.7	50.0	56.3	61.1	37.5	58.3	55.0
Turner et al., 2021	STRIDE-II: an update on the selecting therapeutic targets in inflammatory bowel disease (STRIDE) initiative of the International Organization for the Study of IBD (IOIBD): determining therapeutic goals for treat-to-target strategies in IBD.	61.1	72.2	64.6	61.1	50.0	91.7	66.8
Wei et al., 2017	Management of Crohn’s disease in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease.	55.6	38.9	25.0	61.1	37.5	8.3	37.7

Author	Bonovas	Bonovas	Chande	Chen	Cholapranee	Cohen	Davies	De Cassan	Dignass	Feagan	Feagan	Ford	Gisbert
Year	2018	2019	2014	2016	2017	2000	2020	2012	2019	2012	2012b	2011	2002
1. Did the research questions and inclusion criteria for the review include the components of PICO?	Yes	Yes	Yes	Yes	Yes	No	Yes	No	Yes	Yes	Yes	Yes	No
*2. Did the review report contain an explicit statement that the review methods were established before the conduct of the review, and did the report justify any significant deviations from the protocol?	No	No	Yes	No	No	No	Yes	No	No	Yes	Yes	No	No
3. Did the review authors explain their selection of the study designs for inclusion in the review?	Yes	Yes	Yes	Yes	Yes	No	Yes	No	Yes	Yes	Yes	Yes	No
*4. Did the review authors use a comprehensive literature search strategy?	Yes	Yes	Yes	Yes	Partial	Partial	Yes	Yes	Yes	Yes	Yes	Yes	Yes
5. Did the review authors perform study selection in duplicate?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes	Yes	No
6. Did the review authors perform data extraction in duplicate?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes	Yes	No
*7. Did the review authors provide a list of excluded studies and justify the exclusions?	Yes	Yes	Yes	Yes	Yes	No	Yes	No	No	Yes	Yes	Yes	No
8. Did the review authors describe the included studies in adequate detail?	Partial	Yes	Yes	Yes	Yes	Partial	Yes	Yes	Yes	Yes	Yes	Yes	Partial
*9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies included in the review?	Yes	Yes	Yes	Yes	Yes	No	Yes	No	No	Yes	Yes	Yes	No
10. Did the review authors report on the sources of funding for the studies included in the review?	No	No	Yes	No	No	No	Yes	No	No	Yes	Yes	No	No
*11. If meta-analysis was performed, did the review authors use appropriate methods for the statistical combination of results?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No meta-analysis	Yes	Yes	Yes	Yes	No meta-analysis
12. If a meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or other evidence synthesis?	No	Yes	Yes	No	Yes	No	Yes	No meta-analysis	No	Yes	Yes	No	No meta-analysis
*13. Did the review authors account for RoB in individual studies when interpreting/ discussing the review results?	Yes	Yes	Yes	Yes	No	No	Yes	No	No	Yes	Yes	No	No
14. Did the review authors provide a satisfactory explanation for and discussion of any heterogeneity observed in the results?	Yes	Yes	Yes	Yes	Yes	No	Yes	No	No	Yes	Yes	Yes	No
*15. If they performed quantitative synthesis, did the review authors conduct an adequate investigation of publication bias (small study bias) and discuss its likely impact on the review results?	No	Yes	Yes	N/A	Yes	No	Yes	No meta-analysis	No	Yes	Yes	Yes	No meta-analysis
16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review?	Yes	No	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No
Rating overall	Low	Low	High	Low	Critically Low	Critically Low	High	Critically Low	Critically Low	High	High	Critically Low	Critically Low

Author	Guo	Huang	Iheozor-Ejiofor	Jin	Kaur	Khan	Lasa	Lasa	Leung	Liu	Luan	Lv	Ma	Manguso
Year	2019	2011	2020	2015	2020	2011	2017	2021	2008	2015	2016	2014	2019	2007
1. Did the research questions and inclusion criteria for the review include the components of PICO?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
*2. Did the review report contain an explicit statement that the review methods were established before the conduct of the review, and did the report justify any significant deviations from the protocol?	No	No	Yes	No	Yes	No	No	Yes	No	No	No	No	No	No
3. Did the review authors explain their selection of the study designs for inclusion in the review?	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	No	No	Yes	Yes	Yes
*4. Did the review authors use a comprehensive literature search strategy?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	yes	yes	Yes
5. Did the review authors perform study selection in duplicate?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	yes	yes	Yes
6. Did the review authors perform data extraction in duplicate?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	yes	yes	Yes
*7. Did the review authors provide a list of excluded studies and justify the exclusions?	Partial	No	Yes	Yes	Yes	Yes	Yes	Partial	Yes	Yes	No	Partial	Yes	Yes
8. Did the review authors describe the included studies in adequate detail?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Partial	Yes	Yes	Yes
*9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies included in the review?	Yes	Yes	Yes	Yes	Yes	Yes	Partial	Yes	Partial	No	No	Yes	Partial	Yes
10. Did the review authors report on the sources of funding for the studies included in the review?	No	No	Yes	No	Yes	No	No	No	No	No	No	No	No	No
*11. If meta-analysis was performed, did the review authors use appropriate methods for the statistical combination of results?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
12. If a meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or other evidence synthesis?	No	Yes	Yes	No	Yes	Yes	No	No	Yes	No	No	Yes	Yes	No
*13. Did the review authors account for RoB in individual studies when interpreting/ discussing the review results?	Yes	Yes	Yes	No	Yes	Yes	No	Yes	Yes	No	No	Yes	Yes	No
14. Did the review authors provide a satisfactory explanation for and discussion of any heterogeneity observed in the results?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
*15. If they performed quantitative synthesis, did the review authors conduct an adequate investigation of publication bias (small study bias) and discuss its likely impact on the review results?	Yes	Yes	Yes	N/A	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review?	Yes	No	Yes	No	Yes	Yes	Yes	Yes	No	Yes	No	Yes	Yes	Yes
Rating overall	Low	Low	High	Critically Low	High	Low	Critically Low	Moderate	Low	Critically Low	Critically Low	Low	Low	Critically Low

Author	Manguso	Mardini	Marshall	Marshall	Marshall	Murray	Narula	Nguyen	Nikfar	Rahimi	Sang	Shen	Sherlock	Singh
Year	2016	2014	1997	2012	2010	2020	2018	2018	2009	2009	2010	2014	2015	2020
1. Did the research questions and inclusion criteria for the review include the components of PICO?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
*2. Did the review report contain an explicit statement that the review methods were established before the conduct of the review, and did the report justify any significant deviations from the protocol?	No	No	No	Yes	Yes	Yes	Yes	Yes	No	No	No	No	Yes	Partial
3. Did the review authors explain their selection of the study designs for inclusion in the review?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
*4. Did the review authors use a comprehensive literature search strategy?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Partial
5. Did the review authors perform study selection in duplicate?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
6. Did the review authors perform data extraction in duplicate?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
*7. Did the review authors provide a list of excluded studies and justify the exclusions?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	No	No	No	No	Yes	No
8. Did the review authors describe the included studies in adequate detail?	Yes	Yes	Partial	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
*9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies included in the review?	Yes	Yes	No	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Partial
10. Did the review authors report on the sources of funding for the studies included in the review?	No	No	No	Yes	Yes	Yes	Yes	Yes	Yes	No	No	Yes	Yes	Yes
*11. If a meta-analysis was performed, did the review authors use appropriate methods for the statistical combination of results?	Yes	Yes		Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
12. If a meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or other evidence synthesis?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	No	No	No	Yes	No
*13. Did the review authors account for RoB in individual studies when interpreting/ discussing the review results?	Yes	Yes	No	Yes	Yes	Yes	Yes	Yes	No	No	No	No	Yes	No
14. Did the review authors provide a satisfactory explanation for and discussion of any heterogeneity observed in the results?	Yes	Yes	No	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes	Yes	Yes
*15. If they performed quantitative synthesis, did the review authors conduct an adequate investigation of publication bias (small study bias) and discuss its likely impact on the review results?	Yes	Yes	No	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes	Yes	Yes
16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	No	Yes	Yes	Yes
Rating overall	Low	Low	Critically Low	High	High	High	High	High	Critically Low	Critically Low	Critically Low	Critically Low	High	Critically Low

Author	Sutherland	Wang	Welty	Zeng	Zhao	Zhao
Year	1993	2016	2020	2017	2016	2017
1. Did the research questions and inclusion criteria for the review include the components of PICO?	Yes	Yes	Yes	Yes	Yes	Yes
*2. Did the review report contain an explicit statement that the review methods were established before the conduct of the review, and did the report justify any significant deviations from the protocol?	No	Yes	Yes	Partial	No	No
3. Did the review authors explain their selection of the study designs for inclusion in the review?	Yes	Yes	Yes	Yes	Yes	Yes
*4. Did the review authors use a comprehensive literature search strategy?	Yes	Yes	Yes	Yes	Yes	Yes
5. Did the review authors perform study selection in duplicate?	No	Yes	Yes	Yes	Yes	Yes
6. Did the review authors perform data extraction in duplicate?	No	Yes	Yes	Yes	Yes	Yes
*7. Did the review authors provide a list of excluded studies and justify the exclusions?	No	Yes	No	No	No	No
8. Did the review authors describe the included studies in adequate detail?	Partial	Yes	Yes	Yes	Yes	Yes
*9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies included in the review?	Partial	Yes	Yes	Yes	Yes	Yes
10. Did the review authors report on the sources of funding for the studies included in the review?	Yes	Yes	Yes	No	Yes	Yes
*11. If meta-analysis was performed, did the review authors use appropriate methods for the statistical combination of results?	Yes	Yes	Yes	Yes	Yes	Yes
12. If a meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or other evidence synthesis?	No	Yes	No	No	No	Yes
*13. Did the review authors account for RoB in individual studies when interpreting/ discussing the review results?	No	Yes	No	No	Yes	Yes
14. Did the review authors provide a satisfactory explanation for and discussion of any heterogeneity observed in the results?	No	Yes	Yes	Yes	Yes	Yes
*15. If they performed quantitative synthesis, did the review authors conduct an adequate investigation of publication bias (small study bias) and discuss its likely impact on the review results?	No	Yes	No	Yes	No	Yes
16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review?	No	Yes	Yes	Yes	Yes	Yes
Rating overall	Critically Low	High	Critically Low	Critically Low	Critically Low	Low

[1] Corresponding author: Marcello Imbrizi. E-mail: marcelloimbrizi@gmail.com

P	Adults (≥18 years) with mild-to-moderately active ulcerative colitis
I	• Corticosteroids (budesonide MMX + all traditional)
	• Salicylates (sulfasalazine, mesalazine, mesalazine MMX, suppository, and enema)
	• Immunosuppressants (azathioprine, 6MP, cyclosporine, tacrolimus)
	• Biological
	◆ Anti-TNF (infliximab, golimumab, adalimumab)
	◆ Anti-Integrin (vedolizumab)
	◆ Anti-Interleukin (ustekinumab)
	• JAK inhibitors (tofacitinib, upadacitinib)
	• S1P receptor modulators (ozanimod)
C	Not applicable
O	Not applicable
Type of study	Consensus or guidelines limited to 2016-2021.

P	Adults (≥ 18 years) with moderate-to-severe active UC
I	• Corticosteroids (budesonide MMX + all traditional)
	• Salicylates (sulfasalazine, mesalazine, mesalazine MMX, suppository, and enema)
	• Immunosuppressants (azathioprine, 6MP, cyclosporine, tacrolimus)
	• Biological
	◆ Anti-TNF (infliximab, golimumab, adalimumab)
	◆ Anti-integrin (vedolizumab)
	◆ Anti-interleukin (ustekinumab)
	• JAK inhibitors (tofacitinib, upadacitinib)
	• S1P receptor modulators (ozanimod)
C	Not applicable
O	Consensus or guideline recommendation
Type of study	Consensus or guidelines limited to 2016-2021.

P	Adults (≥18 years) with mild-to-moderate active UC
I	• Corticosteroids (budesonide MMX + all traditional)
	• Salicylates (sulfasalazine, mesalazine, mesalazine MMX, suppository, and enema)
	• Immunosuppressants (azathioprine, 6MP, cyclosporine, tacrolimus)
	• Biological
	◆ Anti-TNF (infliximab, golimumab, adalimumab)
	◆ Anti-integrin (vedolizumab)
	◆ Anti-interleukin (ustekinumab)
	• JAK inhibitors (tofacitinib, upadacitinib)
	• S1P receptor modulators (ozanimod)
C	Not applicable
O	Consensus or guideline recommendation
Type of study	Consensus or guidelines limited to 2016-2021.

P	Adults (≥ 18 years) with moderate-to-severe active UC
I	• Corticosteroids (budesonide MMX + all traditional)
	• Salicylates (sulfasalazine, mesalazine, mesalazine MMX, suppository, and enema)
	• Immunosuppressants (azathioprine, 6-MP, cyclosporine, tacrolimus)
	• Biological
	◆ Anti-TNF (infliximab, golimumab, adalimumab)
	◆ Anti-Integrin (vedolizumab)
	◆ Anti-Interleukin (ustekinumab)
	• JAK inhibitors (tofacitinib, upadacitinib)
	• S1P receptor modulators (ozanimod)
C	Not applicable
O	Consensus or guideline recommendation
Type of study	Consensus or guidelines limited to 2016-2021

P	Adults (≥18 years) with active UC
I	Not applicable
C	Not applicable
O	Criteria used to assess the efficacy of treatment:
	• Clinical response
	• Clinical remission
	• Endoscopic response
	• Endoscopic remission
	• Histological remission
	• Corticosteroid-free clinical remission
	• Improves quality of life
	• Adverse events
	• Others found in the literature
Type of study	Consensus or guidelines limited to 2016-2021

Brasil

Brasil

Segundo Consenso Brasileiro no manejo da retocolite ulcerativa em adultos: um consenso da Organização Brasileira para Doença de Crohn e Colite (GEDIIB)

RESUMO

Contexto:

Objetivo:

Métodos:

Resultados e conclus