Clinical outcomes of best practices for the treatment of distal ulcerative colitis

Distal ulcerative colitis (DUC), affecting 30–50% of ulcerative colitis (UC) patients, is a subtype characterized by inflammation limited to the rectum and sigmoid colon. The pathogenesis involves a complex interplay of genetic, environmental, and immune factors, with cytokines like TNF-α, IL-1β, IL-6, and IL-17 playing significant roles. Despite therapeutic advancements, distal ulcerative colitis presents unique challenges due to its localized nature and diverse response to treatments. This review examined 50 randomized controlled trials (RCTs) that explored pharmacological and non-pharmacological interventions for distal ulcerative colitis, focusing on symptom remission, mucosal healing, and quality-of-life outcomes. Key findings revealed that pharmacologic treatments, particularly 5-aminosalicylic acid (5-ASA), corticosteroids, and biologics, effectively achieved remission, with combined therapies beneficial in refractory cases. Non-pharmacologic strategies, including lifestyle modifications and patient education, further supported treatment efficacy by enhancing patient adherence and outcomes. Importantly, trials highlighted that individualized approaches – such as early biologic therapy for patients with moderate-to-severe disease, dose adjustments based on patient demographics, and tailored lifestyle recommendations – enhanced treatment response and patient quality of life. The review underscores the necessity of personalized management strategies that integrate these findings to address distal ulcerative colitis’s heterogeneous nature and improve long-term patient outcomes.