Clinical guide
Therapeutic guidelines on ulcerative colitis: A GRADE methodology based effort of GETECCU
Pautas terapéuticas en la colitis ulcerosa: un esfuerzo de GETECCU basado en la metodología GRADE
Fernando Gomollóna,◊,
, Santiago García-Lópezb,◊, Beatriz Siciliac,◊, Javier P. Gisbertd,◊, Joaquín Hinojosae,◊
Corresponding author
a Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Zaragoza, Spain
b Department of Gastroenterology, Hospital Universitario Miguel Servet, Zaragoza, Spain
c Department of Gastroenterology, Hospital Universitario de Burgos, Burgos, Spain
d Department of Gastroenterology, Hospital Universitario de La Princesa, CIBEREHD, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain
e Department of Gastroenterology, Hospital de Manises, Valencia, Spain
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As there is no single pathognomonic criterion to define it, a combination of clinical, endoscopic, microbiologic and histological criteria is required to reach the final diagnosis.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Its extension and severity vary from patient to patient, and from time to time in the same patient; hence, the definition of a clinical scenario demands to know both the severity and extension of the disease at a particular moment, according to the widely accepted “Montreal Classification”.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The incidence and prevalence of UC have increased considerably over the last decades,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Spain being no exception; in fact, recent data do show incidence rates that are very similar to those previously described in northern European countries.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Currently, the different treatment methods include numerous nutritional, monitoring, follow-up, surgical, and especially pharmacological alternatives.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> Their application over the broad range of clinical scenarios, with such diverse individual, clinical and social circumstances, is not always easy, and this greatly justifies the need for guidelines. In fact, over the past years a number of guidelines have been published, the most notable being the ECCO guidelines,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> the BSG guidelines,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> the ACG guidelines,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> the WGO guidelines,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> the Asian-Pacific guidelines,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and most recently, the Colombian guidelines.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> All of them are of high quality and evidence-based, but they are all based, without exception, on a relatively wide <span class="elsevierStyleItalic">consensus</span> process.</p><p id="par0015" class="elsevierStylePara elsevierViewall">GETECCU (Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa) is a 21-year-old Spanish working group on inflammatory bowel diseases, and its main goal is to improve the management of these diseases in Spain by promoting research, educational programs, and by improving care. After developing several consensus guidelines on the use of infliximab,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> TBC prevention,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and apheresis,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> the GETECCU board decided to go a step further and start a program of evidence-based practice guidelines following the GRADE (Grades of Recommendation Assessment, Development and Evaluation) methodology<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> and fulfilling AGREE (Appraisal of Guidelines, Research and Evaluation) collaboration requirements.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> This therapeutic UC guideline is the first result of this program. This report is the short form of the document; the complete document is fully available at http://dx.doi.org/10.1016/j.gastrohep.2012.11.002.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Definitions</span><p id="par0020" class="elsevierStylePara elsevierViewall">The criteria for the primary diagnosis are those of Lennard–Jones, widely accepted,<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,10</span></a> and for severity and extension, the Montreal Classification is used.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> To evaluate the results of the studies available in the literature, it is necessary to rely on several diverse and generally poorly validated indexes such as the Truelove-Witts, the Mayo Index, SEO's Index, Lichtiguer's Index, and Walmsley's Index (also known as SAI or simple activity index). The PUCAI index has the advantage of a correct methodological validation, but has been used only in pediatric studies. The details and references of these indexes are available in the full version of the guideline.</p><p id="par0025" class="elsevierStylePara elsevierViewall">There are other definitions that are commonly used in UC literature, such as <span class="elsevierStyleItalic">remission</span>,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a><span class="elsevierStyleItalic">response, relapse, Steroid dependence, Steroide resistance, pouchitis and cuffitis</span> that are somewhat arbitrary. A widely accepted consensus is needed, and for the purpose of the guideline, ECCO definitions are accepted<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> (see the full version for details).</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Objectives</span><p id="par0030" class="elsevierStylePara elsevierViewall">First, the Guideline Elaboration Committee defined the objectives, following the GRADE methodology. In sum, after choosing three broad clinical scenarios to which recommendations may be applied (induction of remission in severe colitis, induction of remission in mild-moderate colitis, and maintenance of remission), in each of them the possible outcome variables were defined in a scale of 1–9 (1–3 is not included, 4–6 is important but not critical, and 7–9 is considered critical for decision-making). After being scored by the nine members of the Committee, those outcome variables with an average score above 4 were included. In all the critical variables, the degree of internal agreement was excellent, with unanimity or with a maximum variability of one point. This process defined the following variables as Clinical Practice Guideline <span class="elsevierStyleItalic">objectives</span>:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0035" class="elsevierStylePara elsevierViewall">To establish recommendations for the <span class="elsevierStyleItalic"><span class="elsevierStyleUnderline">induction treatment in severe UC flares</span></span>, prioritizing the following assessment variables:<elsevierMultimedia ident="tbl0005"></elsevierMultimedia></p></li></ul><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0040" class="elsevierStylePara elsevierViewall">To establish recommendations for the <span class="elsevierStyleItalic"><span class="elsevierStyleUnderline">induction treatment in mild-moderate UC flares</span></span>, prioritizing the following assessment variables:<elsevierMultimedia ident="tbl0010"></elsevierMultimedia></p></li></ul><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0045" class="elsevierStylePara elsevierViewall">To establish recommendations for the <span class="elsevierStyleItalic"><span class="elsevierStyleUnderline">maintenance of UC in remission</span></span>, prioritizing the following assessment variables:<elsevierMultimedia ident="tbl0015"></elsevierMultimedia></p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">General methodology</span><p id="par0050" class="elsevierStylePara elsevierViewall">First, a Design Committee from the GETECCU board set out the general goals and a nine-member Elaboration Committee defined the clinical scenarios and assessment variables, as previously stated. Second, a five-member Working Committee drafted the first document. This document was submitted to be reviewed by an Internal Review Committee. After this process was carried out, the Working Committee prepared a second version of the document. This document was submitted to further review by an External Review Committee, which included gastroenterologists, surgeons, primary care physicians, nurses and patients. Finally, the Working Committee drafted the final document.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The Working Committee followed the GRADE methodology<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20,21</span></a> (see <a href="http://www.gradeworkinggroup.org/">www.gradeworkinggroup.org</a>) and classified the recommendations for the different clinical scenarios into four clear and easy-to-understand final categories:<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a><span class="elsevierStyleItalic">strong recommendation for an intervention</span>, implying for the clinician to <span class="elsevierStyleItalic">do it</span>; <span class="elsevierStyleItalic">weak recommendation for an intervention, which</span> implies to <span class="elsevierStyleItalic">probably do it</span>; <span class="elsevierStyleItalic">weak against an intervention</span>, implying to <span class="elsevierStyleItalic">probably do not do it</span>; and <span class="elsevierStyleItalic">strong against an intervention</span>, implying <span class="elsevierStyleItalic">not to do it</span>. Defined using the GRADE methodology, these recommendations were mainly, but not solely, based on the strict assessment of the quality of the evidence (high, moderate, low, or very low quality). The quality of the evidence may be <span class="elsevierStyleItalic">downgraded</span> as a result of limitations in the study design or in its implementation, imprecision of estimates (wide confidence intervals), variability in the results, indirectness of the evidence, or publication bias; or <span class="elsevierStyleItalic">upgraded</span> because of a very large magnitude of effects, a dose-response gradient, or if all the plausible biases would reduce an apparent treatment effect. Furthermore, the recommendations are also based on some other factors, such as desirable and undesirable consequences of alternative management strategies, variability in values and preferences, and the use of resources (costs).</p><p id="par0060" class="elsevierStylePara elsevierViewall">Finally, we used the Agree instrument (see <a href="http://www.agreecollaboration.org/">www.agreecollaboration.org</a>) to ensure the high quality of our Clinical Practice Guideline, which was evaluated by the authors and the entire internal review Committee.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical scenarios and clinical questions: Treatment algorithms</span><p id="par0065" class="elsevierStylePara elsevierViewall">After defining those three broad clinical scenarios, the information available in the medical literature needs to be reviewed and classified. Taking into account the critical variables defined following the GRADE methodology, the possible clinical scenarios, the therapeutic alternatives available, and the available literature, a total of 32 relevant clinical questions were formulated (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 1</a>). A systematic review of the literature and an evaluation of the evidence were undertaken for each of the 32 questions, once again following the GRADE methodology, with the pertinent performance of specific tables when possible (available on request), finally making the appropriate recommendations (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 2</a>). The responses to these questions were the basis for six different algorithms for guiding clinical decisions (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1–6</a>). The complete text of the guide contains a summary of the evidence for each particular question, recommendations, written comments for the algorithms, 17 tables, 3 “boxes” of general comments on methodology, 6 algorithms and several appendices (available at http://dx.doi.org/10.1016/j.gastrohep.2012.11.002).</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Recommendations</span><p id="par0070" class="elsevierStylePara elsevierViewall">In two of the 32 clinical questions, it was not possible to reach a recommendation because the evidence available was considered of very low quality (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 2</a>).</p><p id="par0075" class="elsevierStylePara elsevierViewall">The response was categorized as a <span class="elsevierStyleItalic">strong recommendation against</span> an intervention in three questions, with very low quality of evidence in two of them and low quality in one (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 2</a>).</p><p id="par0080" class="elsevierStylePara elsevierViewall">In five questions, the response was a <span class="elsevierStyleItalic">weak recommendation against</span> an intervention, based all on low quality evidence.</p><p id="par0085" class="elsevierStylePara elsevierViewall">In eight questions, there was a <span class="elsevierStyleItalic">weak recommendation for</span> an intervention, based three times on moderate quality evidence and five on low quality evidence.</p><p id="par0090" class="elsevierStylePara elsevierViewall">In fourteen occasions, we found evidence to support a <span class="elsevierStyleItalic">strong recommendation for</span> an intervention, although high quality evidence was available only in five of them, the rest being only of moderate quality.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">UC is a chronic disease with very diverse clinical scenarios, in which several different treatments are available, and with a high variability in clinical practice.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Therefore, the need of clinical guidelines seems evident. In fact, in the last 10 years, a number of consensus guidelines have appeared,<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7–12</span></a> in addition to a number of expert recommendations. Although we lack direct evidence of its use in real practice, the ECCO guidelines are probably widely known, as they are very frequently cited in the literature. In addition, ECCO has a specific program of workshops to disseminate the guidelines recommendations. In fact, at least in Spain we know that clinicians treating UC patients have a very good knowledge of the ECCO statements, and a very good agreement with its recommendations has been confirmed.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> All the guidelines available are evidence-based, but all of them rely on a <span class="elsevierStyleItalic">consensus</span> process without a specific systematic methodology for a true Clinical Practice Guideline.</p><p id="par0100" class="elsevierStylePara elsevierViewall">As previously mentioned, the present guideline tries to follow the recommendations of the AGREE initiative,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> using the currently widely accepted GRADE methodology.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16,22</span></a> A formal comparison with available guidelines is a difficult task that exceeds the scope of this report. In our view, to follow the GRADE methodology has the advantage of a systematic approach, taking into account not only the high-quality evidence available, but also observational data, social and cost-related considerations, and the experience of the authors and reviewers.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> The final 32 recommendations and 6 algorithms proposed could help the clinician in the rather complex process of making decisions in the daily practice, in a system that is very easy to grasp.</p><p id="par0105" class="elsevierStylePara elsevierViewall">There are, however, some limitations to be considered. First, a final guideline can only be only as good as the evidence that is available.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> We could only base our recommendation on high-quality evidence in 5 out of 32 cases, and we had to classify the quality as moderate in 12 more questions; hence, in almost 50% of the scenarios defined, the quality of the evidence is low or very low. It is clear that we need more high-quality clinical research in this field. Furthermore, there is a clear limitation in the literature available: definitions of disease activity are very different among the studies reported. This makes it especially difficult to compare the results among the different reports and populations, and the elaboration of GRADE tables has been very difficult in some of the questions, and even impossible in others. Finally, the use of a systematic methodology cannot eliminate personal bias completely. Although we have undertaken a complete and elaborate process of internal and external review, with several rounds (with more than 40 people contributing, including surgeons, nurses and patients), we cannot completely exclude this bias.</p><p id="par0110" class="elsevierStylePara elsevierViewall">This is the short version and its full version is available online.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">This guide has been possible to some extent by an unrestricted grant of MSD. MSD was not involved in any part of the development or scientific aspects of the guide.</p><p id="par0120" class="elsevierStylePara elsevierViewall">F. Gomollón has received grants for assistance to scientific meetings from Abbott and MSD. He has also received consultancy fees from FAES-FARMA, Abbott and MSD. He has also received research support from MSD.</p><p id="par0125" class="elsevierStylePara elsevierViewall">S. García-López has received grants for assistance to scientific meetings from Abbott, MSD, FAES-FARMA, Ferring and Shire. He has also received consultancy fees from Abbott and MSD.</p><p id="par0130" class="elsevierStylePara elsevierViewall">B. Sicilia has received grants for assistance to scientific meetings from Abbott, MSD, FAES-FARMA, Ferring y Shire.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Javier P Gisbert has received grants for assistance to scientific meetings from Abbott and MSD. He has also received consultancy fees from FAES-FARMA, Abbott and MSD.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Joaquin Hinojosa has received grants for assistance to scientific meetings from Abbott and MSD. He has also received consultancy fees from FAES-FARMA, Abbott and MSD.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres162212" "titulo" => array:5 [ 0 => "Abstract" 1 => "Background and aim" 2 => "Methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec150395" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres162211" "titulo" => array:5 [ 0 => "Resumen" 1 => "Antecedentes y objetivo" 2 => "Métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec150396" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Definitions" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Objectives" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "General methodology" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Clinical scenarios and clinical questions: Treatment algorithms" ] ] ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Recommendations" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflict of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-09-23" "fechaAceptado" => "2012-09-27" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec150395" "palabras" => array:4 [ 0 => "Ulcerative colitis" 1 => "Therapy" 2 => "Clinical Practice Guidelines" 3 => "GRADE methodology" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec150396" "palabras" => array:4 [ 0 => "Colitis ulcerosa" 1 => "Terapia" 2 => "Guías de Práctica Clínica" 3 => "Metodología GRADE" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Background and aim</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evidence-based clinical guidelines on Ulcerative colitis (UC) have been developed through a consensus, while GRADE methodology is the current standard for guideline development. This is the first one based on GRADE methodology on UC.</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Following GRADE methodology, the Spanish Group of Ulcerative Colitis and Crohn's disease (GETECCU) have developed a guideline on UC treatment. After selection of relevant clinical scenarios, 32 clinical questions were chosen and recommendations were established.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In 2 questions no recommendation was possible. Twenty-two actions were recommended for, 14 strongly and 8 weakly. However, in 8 questions a recommendation against doing something was obtained, weak in 5 and strong in 3. The majority of recommendations were based on moderate quality evidence, and only 5 on high-quality evidence.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">With GRADE methodology we find a clear recommendation on possible actions in most clinical decisions in UC treatment, but much more clinical high-quality research is needed.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Antecedentes y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Las guías clínicas para la colitis ulcerosa (CU), basadas en la evidencia, se elaboran a través del consenso; por otra parte, la metodología GRADE es el estándar actual para la elaboración de directrices. Esta es la primera guía para la CU que se basa en la metodología GRADE.</p> <span class="elsevierStyleSectionTitle">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">De acuerdo con la metodología GRADE, el Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa (GETECCU) ha elaborado una guía sobre el tratamiento de la CU. Después de seleccionar los escenarios clínicos pertinentes, se eligieron 32 preguntas clínicas y se establecieron recomendaciones.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En 2 preguntas no fue posible realizar recomendación alguna. Se recomendaron 22 acciones, 14 con un grado de recomendación sólido y 8 con grado débil. Sin embargo, para 8 preguntas se obtuvo una recomendación en contra de realizar una acción, y de ellas, 5 resultaron recomendaciones sólidas y 3 débiles. La mayoría de las recomendaciones se basaron en pruebas de una calidad moderada, y sólo 5 pruebas se pudieron considerar de alta calidad.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Con la metodología GRADE encontramos una clara recomendación acerca de acciones posibles durante la mayoría de las decisiones clínicas realizadas para el tratamiento de la CU, pero se necesita mucho más investigación clínica de alta calidad.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "◊" "nota" => "<p class="elsevierStyleNotepara">On behalf of GETECCU (Grupo Español de Trabajo de Enfermedad de Crohn y Colitis Ulcerosa or Spanish Group for Working on Crohn's Disease and Ulcerative Colitis).</p>" ] ] "multimedia" => array:11 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3335 "Ancho" => 2500 "Tamanyo" => 361253 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Treatment of severe flare.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3230 "Ancho" => 2500 "Tamanyo" => 434401 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Treatment of mild-moderate flare.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2728 "Ancho" => 2500 "Tamanyo" => 336331 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Treatment of remission induced by mesalazine (or oral steroids of low-availability).</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 3197 "Ancho" => 2500 "Tamanyo" => 525281 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Treatment of remission induced by systemic steroids.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 3042 "Ancho" => 2500 "Tamanyo" => 444991 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Treatment of remission induced by infliximab.</p>" ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 3054 "Ancho" => 2500 "Tamanyo" => 288528 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Treatment of remission induced by cyclosporine.</p>" ] ] 6 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Induction of remission in severe ulcerative colitis flares</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Are steroids effective in the induction of remission in patients with a severe UC flare? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Is cyclosporine effective in the induction of remission in patients with a severe UC flare? And in steroid-resistance? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Is tacrolimus effective in the induction of remission in patients with a severe UC flare? And in steroid-resistance? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Is infliximab effective in the induction of remission in patients with a severe UC flare? And in steroid-resistance? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Is heparin (at anticoagulant dose) effective in the induction of remission in patients with a severe UC flare? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Are antibiotics effective in the induction of remission in patients with a severe UC flare? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Is surgery effective in the induction of remission in patients with a severe UC flare? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Is parenteral nutrition effective in the induction of remission in patients with a severe UC flare? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Induction of remission in mild to moderate ulcerative colitis flare</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Are oral salicylates effective in the induction of remission in patients with a mild-moderate UC flare? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Is combined treatment with oral and rectal salicylates more effective than oral alone in the induction of remission in patients with a mild-moderate UC flare? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Are rectal salicylates alone effective in the induction of remission in mild-moderate flares of left-sided colitis? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Are rectal salicylates more effective than oral salicylates in the induction of remission in patients with a moderate flare of left-sided UC? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Are systemic steroids effective in the induction of remission in patients with mild-moderate UC flares? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Are oral steroids of low-bioavailability effective in the induction of remission in mild-moderate UC flares? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Are rectal steroids effective in the induction of remission in mild-moderate left-sided UC flares? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Are rectal steroids of low bioavailability more effective than those of high bioavailability in the induction of remission in patients with mild-moderate left-sided UC flares? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Are rectal salicylates more effective than rectal steroids in the induction of remission in patients with a mild-moderate left-sided UC flare? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Are thiopurines effective in the induction of remission in patients with a moderate flare of steroid-resistant or steroid-dependent UC? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Is methotrexate effective in the induction of remission in patients with a moderate flare of steroid-dependent UC? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Is infliximab effective in the induction of remission in patients with a moderate flare of steroid-dependent or steroid-resistant UC? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Is adalimumab effective in the induction of remission in patients with a moderate flare of steroid-dependent or steroid-resistant UC? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Is treatment with aphaeresis effective in the induction of remission in patients with a moderate flare of steroid-dependent UC? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Maintenance treatment of patients with ulcerative colitis in remission</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Is treatment with oral salicylates effective in the maintenance of remission in patients after a mild-moderate UC flare treated with salicylates? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Is treatment with rectal salicylates effective in the maintenance of remission in patients after a mild-moderate flare of left-sided UC treated with salicylates? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Is treatment with thiopurines effective in the maintenance of remission in patients after a mild-moderate flare of steroid-dependent UC? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Is treatment with methotrexate effective in the maintenance of remission in patients after a mild-moderate flare of steroid-dependent UC? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Is treatment with infliximab effective in the maintenance of remission in patients after a mild-moderate flare of steroid-dependent or steroid-resistant UC? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Is maintenance treatment with thiopurines effective in patients with severe UC who have obtained remission with infliximab? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Is maintenance treatment with infliximab effective in patients with severe UC who have obtained remission with infliximab? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Is maintenance treatment with thiopurines effective in patients with severe UC who have obtained remission with cyclosporine? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Is maintenance treatment with cyclosporine effective in patients with severe UC who have obtained remission with cyclosporine? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Is maintenance treatment with tacrolimus effective in patients with severe UC who have obtained remission with tacrolimus? \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab258429.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">The 32 clinically relevant questions formulated.</p>" ] ] 7 => array:7 [ "identificador" => "tbl0025" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Action (and clinical scenary) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Quality of evidence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Recommendation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">For the clinician \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Induction treatment in Severe UC flare</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IV steroids \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleUnderline">Moderate</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Strong for (recommended) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do it \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IV cyclosporine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Strong for (recommended) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do it \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tacrolimus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weak for (suggested) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Probably do it \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Infliximab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Strong for (recommended) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do it \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleUnderline">Heparin (anticoagulant)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleUnderline">Low</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Strong against (not recommended) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do not do it \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Antibiotics \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Very low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No recommendation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weak for (suggested) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Probably do it \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Parenteral Nutrition \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weak against (not suggested) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Probably do not it \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Induction treatment in Mild-moderate UC flare</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Oral salicylates \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Strong for (recommended) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do it \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Oral and rectal salicylantes (vs oral alone) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weak for (suggested) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Probably do it \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Rectal salicilates alone (leeft-colitis) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Strong for (recommended) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do it \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Rectal preferred vs oral (salicylates, alone, left-colitis) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Strong for (recommended) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do it \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Systemic steroids \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Strong for (recommended) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do it \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Low-bioavailability oral steroids \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weak for (suggested) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Probably do it \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Rectal steroids alone (left-colitis) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weak for (suggested) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Probably do it \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Rectal vs. systemic steroids (left-colitis) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Strong for (recommended) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do it \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Rectal salicylates vs. rectal steroids (left-sided) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Strong for (recommended) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do it \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Thiopurines for steroid-failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weak against (not suggested) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Probably do not do it \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Methotrexate for steroid-dependent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weak against (not suggested) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Probably do not do it \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Infliximab for steroid-failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Strong for (recommended) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do it \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Adalimumab for steroid-failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weak for (suggested) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Probably do it \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Apheresis for steroid-dependent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weak against (not suggested) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Probably do not do it \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Maintenance treatment of UC in remission</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Oral salicylates (after remission with oral salicylates) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Strong for (recommended) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do it \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Rectal salicylates (after remission with rectal salicylates, left-colitis) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Strong for (recommended) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do it \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Thiopurines for steroid-dependent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Strong for (recommended) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do it \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Methotrexate for steroid-dependent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weak against (not suggested) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Probably do not do it \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Infliximab for steroid failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Strong for (recommended) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do it \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Thiopurine (after remission with infliximab) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Very low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No recommendation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Infliximab (after remission with infliximab) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weak for (suggested) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Probably do it \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Thiopurine (after remission with cyclosporine) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weak for (suggested) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Probably do it \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cyclosporine (after remission with cyclosporine) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Very low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Strong against (not recommended) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do not do it \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tacrolimus (after remission with tacrolimus) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Very low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Strong against (not recommended) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do not do it \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab258425.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Summary of the quality of the evidence and grade of the recommendation for the 32 statements.</p>" ] ] 8 => array:5 [ "identificador" => "tbl0005" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => false "mostrarDisplay" => true "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">∘<span class="elsevierStyleHsp" style=""></span>Avoidance of mortality \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">∘<span class="elsevierStyleHsp" style=""></span>Achievement of clinical remission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">∘<span class="elsevierStyleHsp" style=""></span>Avoidance of surgery (colectomy) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">∘<span class="elsevierStyleHsp" style=""></span>Clinical response \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">∘<span class="elsevierStyleHsp" style=""></span>Safety \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab258428.png" ] ] ] ] ] 9 => array:5 [ "identificador" => "tbl0010" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => false "mostrarDisplay" => true "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">∘<span class="elsevierStyleHsp" style=""></span>Achievement of clinical remission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">∘<span class="elsevierStyleHsp" style=""></span>Safety \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab258427.png" ] ] ] ] ] 10 => array:5 [ "identificador" => "tbl0015" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => false "mostrarDisplay" => true "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">∘<span class="elsevierStyleHsp" style=""></span>Avoidance of relapse \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">∘<span class="elsevierStyleHsp" style=""></span>Safety \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab258426.png" ] ] ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:25 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Classification of inflammatory bowel disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.E. Lennard-Jonnes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Scand J Gastroenterol" "fecha" => "1989" "volumen" => "24" "numero" => "Suppl. 170" "paginaInicial" => "2" "paginaFinal" => "6" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Towards an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a working party of the 2005 Montreal World Congress of gastroenterology" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.S. Silverberg" 1 => "J. Satsangi" 2 => "T. Ahmad" 3 => "I.D. Arnott" 4 => "C.N. Bernstein" 5 => "S.R. Brant" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Can J Gastroenterol" "fecha" => "2005" "volumen" => "19" "numero" => "Suppl. A" "paginaInicial" => "5" "paginaFinal" => "36" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16151544" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N.A. Molodecky" 1 => "I.S. Soon" 2 => "D.M. Rabi" 3 => "W.A. Ghali" 4 => "M. Ferris" 5 => "G. Chernoff" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.gastro.2011.10.001" "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "2012" "volumen" => "142" "paginaInicial" => "46" "paginaFinal" => "54" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22001864" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Alta incidencia de la enfermedad inflamatoria intestinal en Navarra (España). Resultados de un estudio prospectivo y poblacional" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Arín Letamendía" 1 => "F. Borda Celaya" 2 => "M.J. Burusco Paternain" 3 => "C. Prieto Martínez" 4 => "A. Martínez Echeverría" 5 => "I. Elizalde Apestegui" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gastroenterol Hepatol" "fecha" => "2008" "volumen" => "31" "paginaInicial" => "111" "paginaFinal" => "116" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18341841" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Enfermedad inflamatoria intestinal" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.A. Gassull" 1 => "F. Gomollón" 2 => "J. Hinojosa" 3 => "A. Obrador" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "edicion" => "3rd ed." "fecha" => "2007" "editorial" => "Arán" "editorialLocalizacion" => "Madrid" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inflammatory bowel disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.R. Targan" 1 => "F. Shanahan" 2 => "L.C. Karp" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2010" "editorial" => "Wiley-Blackwell" "editorialLocalizacion" => "Oxford" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European evidence-based consensus on the management of ulcerative colitis: current management" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.P.L. Travis" 1 => "E.F. Stange" 2 => "M. Lémann" 3 => "T. Oresland" 4 => "W.A. Bemelman" 5 => "Y. Chowers" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.crohns.2007.11.002" "Revista" => array:6 [ "tituloSerie" => "Journal of Crohn's and Colitis" "fecha" => "2008" "volumen" => "2" "paginaInicial" => "24" "paginaFinal" => "62" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21172195" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines for the management of inflammatory bowel disease in adults" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "on behalf of the IBD Section of the British Society of Gastroenterology" "etal" => false "autores" => array:3 [ 0 => "M.J. Carter" 1 => "A.J. Lobo" 2 => "S.P.L. Travis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/gut.2004.043372" "Revista" => array:7 [ "tituloSerie" => "Gut" "fecha" => "2004" "volumen" => "53" "numero" => "Suppl. 5" "paginaInicial" => "V1" "paginaFinal" => "V16" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15306569" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ulcerative colitis practice guidelines in adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 1 | 3 |
| 2024 October | 32 | 13 | 45 |
| 2024 September | 41 | 20 | 61 |
| 2024 August | 100 | 15 | 115 |
| 2024 July | 47 | 5 | 52 |
| 2024 June | 38 | 5 | 43 |
| 2024 May | 42 | 6 | 48 |
| 2024 April | 39 | 12 | 51 |
| 2024 March | 34 | 10 | 44 |
| 2024 February | 49 | 3 | 52 |
| 2024 January | 59 | 3 | 62 |
| 2023 December | 77 | 8 | 85 |
| 2023 November | 75 | 8 | 83 |
| 2023 October | 72 | 6 | 78 |
| 2023 September | 40 | 4 | 44 |
| 2023 August | 34 | 4 | 38 |
| 2023 July | 77 | 4 | 81 |
| 2023 June | 82 | 0 | 82 |
| 2023 May | 92 | 15 | 107 |
| 2023 April | 48 | 2 | 50 |
| 2023 March | 65 | 12 | 77 |
| 2023 February | 50 | 20 | 70 |
| 2023 January | 56 | 18 | 74 |
| 2022 December | 45 | 8 | 53 |
| 2022 November | 68 | 13 | 81 |
| 2022 October | 59 | 27 | 86 |
| 2022 September | 51 | 21 | 72 |
| 2022 August | 52 | 18 | 70 |
| 2022 July | 54 | 17 | 71 |
| 2022 June | 61 | 22 | 83 |
| 2022 May | 98 | 25 | 123 |
| 2022 April | 54 | 23 | 77 |
| 2022 March | 75 | 14 | 89 |
| 2022 February | 68 | 13 | 81 |
| 2022 January | 66 | 13 | 79 |
| 2021 December | 51 | 12 | 63 |
| 2021 November | 84 | 28 | 112 |
| 2021 October | 58 | 19 | 77 |
| 2021 September | 51 | 13 | 64 |
| 2021 August | 59 | 9 | 68 |
| 2021 July | 39 | 12 | 51 |
| 2021 June | 26 | 13 | 39 |
| 2021 May | 48 | 10 | 58 |
| 2021 April | 148 | 49 | 197 |
| 2021 March | 118 | 28 | 146 |
| 2021 February | 87 | 18 | 105 |
| 2021 January | 87 | 19 | 106 |
| 2020 December | 87 | 19 | 106 |
| 2020 November | 74 | 14 | 88 |
| 2020 October | 66 | 11 | 77 |
| 2020 September | 36 | 14 | 50 |
| 2020 August | 55 | 14 | 69 |
| 2020 July | 43 | 13 | 56 |
| 2020 June | 43 | 8 | 51 |
| 2020 May | 40 | 12 | 52 |
| 2020 April | 47 | 14 | 61 |
| 2020 March | 124 | 16 | 140 |
| 2020 February | 54 | 20 | 74 |
| 2020 January | 55 | 18 | 73 |
| 2019 December | 43 | 18 | 61 |
| 2019 November | 46 | 30 | 76 |
| 2019 October | 50 | 12 | 62 |
| 2019 September | 52 | 17 | 69 |
| 2019 August | 48 | 12 | 60 |
| 2019 July | 69 | 12 | 81 |
| 2019 June | 138 | 36 | 174 |
| 2019 May | 246 | 51 | 297 |
| 2019 April | 101 | 31 | 132 |
| 2019 March | 30 | 16 | 46 |
| 2019 February | 39 | 18 | 57 |
| 2019 January | 107 | 11 | 118 |
| 2018 December | 36 | 8 | 44 |
| 2018 November | 47 | 9 | 56 |
| 2018 October | 101 | 7 | 108 |
| 2018 September | 103 | 13 | 116 |
| 2018 August | 75 | 8 | 83 |
| 2018 July | 43 | 5 | 48 |
| 2018 June | 35 | 7 | 42 |
| 2018 May | 32 | 2 | 34 |
| 2018 April | 34 | 4 | 38 |
| 2018 March | 28 | 6 | 34 |
| 2018 February | 19 | 5 | 24 |
| 2018 January | 24 | 7 | 31 |
| 2017 December | 32 | 2 | 34 |
| 2017 November | 18 | 4 | 22 |
| 2017 October | 22 | 4 | 26 |
| 2017 September | 30 | 9 | 39 |
| 2017 August | 29 | 6 | 35 |
| 2017 July | 27 | 7 | 34 |
| 2017 June | 46 | 9 | 55 |
| 2017 May | 50 | 9 | 59 |
| 2017 April | 35 | 9 | 44 |
| 2017 March | 30 | 39 | 69 |
| 2017 February | 46 | 10 | 56 |
| 2017 January | 37 | 4 | 41 |
| 2016 December | 53 | 7 | 60 |
| 2016 November | 61 | 13 | 74 |
| 2016 October | 88 | 9 | 97 |
| 2016 September | 64 | 17 | 81 |
| 2016 August | 49 | 7 | 56 |
| 2016 July | 40 | 4 | 44 |
| 2016 June | 53 | 13 | 66 |
| 2016 May | 49 | 34 | 83 |
| 2016 April | 54 | 27 | 81 |
| 2016 March | 58 | 22 | 80 |
| 2016 February | 59 | 17 | 76 |
| 2016 January | 47 | 20 | 67 |
| 2015 December | 40 | 11 | 51 |
| 2015 November | 39 | 12 | 51 |
| 2015 October | 37 | 16 | 53 |
| 2015 September | 38 | 13 | 51 |
| 2015 August | 26 | 11 | 37 |
| 2015 July | 24 | 15 | 39 |
| 2015 June | 20 | 14 | 34 |
| 2015 May | 32 | 19 | 51 |
| 2015 April | 27 | 24 | 51 |
| 2015 March | 27 | 24 | 51 |
| 2015 February | 19 | 7 | 26 |
| 2015 January | 2 | 1 | 3 |
| 2014 November | 0 | 1 | 1 |
| 2014 October | 1 | 0 | 1 |
| 2014 September | 0 | 1 | 1 |
| 2014 July | 2 | 1 | 3 |
| 2014 June | 2 | 2 | 4 |
| 2014 May | 2 | 0 | 2 |
| 2014 April | 1 | 1 | 2 |
| 2014 March | 0 | 3 | 3 |
| 2014 February | 1 | 5 | 6 |
| 2014 January | 0 | 2 | 2 |
| 2013 November | 1 | 3 | 4 |
| 2013 October | 0 | 1 | 1 |
| 2013 September | 0 | 2 | 2 |
| 2013 August | 0 | 1 | 1 |
| 2013 July | 1 | 2 | 3 |
| 2013 February | 1178 | 0 | 1178 |
Show all
