Ursodeoxycholic acid may reduce colorectal cancer with concurrent PI3K inhibitor ulcerative colitis and primary sclerosing cholangitis. [II-3,B] Level of agreement: a-69%, b-31%, c-0%, d-0%, e-0% Quality of evidence and Classification of recommendation: as above 5-Aminosalicylic Acid in Maintenance of Remission.  5-ASAs are effective in the maintenance of remission of mild-to-moderate UC. The OR for the failure to maintain clinical or endoscopic remission (withdrawals and relapses) for 5-ASA versus placebo was 0.47 (95% CI: 0.36–0.62). Sulphasalazine may be better than newer 5-ASA preparations in the maintenance of remission in UC but both

formulations were generally safe and well tolerated.169 In Asia, UC tends to be milder with a lower requirement for proctocolectomy. In a review of 172 Chinese UC patients, 84% were on oral and/or topical 5-ASA.77 Distal

UC may be adequately maintained in remission with intermittent topical rectal 5-ASA. To improve adherence, oral 5-ASA treatments may be given once daily, which has a similar efficacy to multiple daily doses.146 5-Aminosalicylic Acid in Dysplasia Chemoprevention.  Colorectal cancer is one of the most devastating complications Dabrafenib in vivo of chronic colitis in the setting of IBD.170 The risk of colitis-associated CRC in Asia is likely to be similar to Western countries and emerging data, such as from the Korean population-based IBD registry, confirms this. In Korea, the overall prevalence of CRC in UC patients was 0.37%. The cumulative risk of UC-associated CRC was 0.7%, 7.9% and 33.2% for the respective disease durations of 10, 20 and 30 years. The use of chemoprophylaxis was not detailed in this study.106 Therefore, the 30-year rate of colitis-associated CRC in Korea exceeds population-based

CRC rates of 2.1–7.5% in Western population studies of the equivalent duration of disease.171 From a meta-analysis that included 334 cases of CRC, 140 cases of dysplasia and a total of 1932 subjects, 5-ASA protected against Tolmetin the development of CRC (OR: 0.51; 95% CI: 0.37–0.69) or a combined endpoint of CRC/dysplasia (OR 0.51; 95% CI: 0.38–0.69).172 Other studies have not shown the chemoprophylactic effect of 5-ASA.173 The high tolerability of 5-ASA and the potential to prevent CRC supports the use 5-ASA chemoprophylaxis. Ursodeoxycholic Acid.  The presence of PSC in the setting of UC significantly increases the risk of CRC with OR 4.79 (95% CI: 3.58–6.41).174 A randomized controlled study of ursodeoxycholic acid in PSC-UC patients found on intention-to-treat analysis a significantly reduced rate of CRC development (RR 0.26; 95% CI: 0.06–0.92).175 Ursodeoxycholic acid (13–15 mg per kilogram of body weight) should therefore be included in all patients with PSC-UC. Fertility, pregnancy, breast feeding, nutrition and osteoporosis are important considerations in the management of UC.