International Delphi Consensus Recommendations: Comprehensive Disease Control Measures in Ulcerative Colitis

Management of ulcerative colitis (UC) necessitates a patient-centered approach and comprehensive disease control that goes beyond conventional definitions of clinical remission, which are typically based on stool frequency and rectal bleeding. Although the STRIDE (Selecting Therapeutic Targets in Inflammatory Bowel Disease) II consensus and guidelines strive to encompass clinical, biochemical, and endoscopic markers as treatment goals, they may overlook some physical and psychological aspects that impact patients’ lives even during disease remission. Thus, a clear definition of comprehensive disease control is needed.

A Delphi consensus panel, comprising 12 gastroenterologists and one patient advocate, was assembled to expand on STRIDE II recommendations. The panel members reviewed responses to a patient survey on preferences and symptoms affecting quality of life during remission, survey responses of panel members, and published literature to develop statements providing specific measurement tools and thresholds. 

Despite an initial greater tolerance of symptoms among physicians than patients, the panel members reached a consensus on clinical markers to define comprehensive disease control. Beyond the items already considered for clinical remission (rectal bleeding and stool frequency), urgency, abdominal pain, extraintestinal manifestations, fatigue, sleep disturbance, and quality of life were also considered. Furthermore, they defined additional indicators of disease control as biochemical markers (particularly fecal calprotectin), endoscopic remission, absence of histological activity, and corticosteroid discontinuation. However, they did not include imaging techniques and discontinuation of other UC therapies as measures of comprehensive disease control due to limited availability and significance, respectively.