Transatlantic divide: First-line therapy for acute colitis

American Gastroenterologists are astonished by the low threshold that European colleagues have for using corticosteroids to treat acute ulcerative colitis. Likewise, European Gastroenterologists regard the massive doses of aminosalicylates used by US colleagues with interest, because they have yet to be convinced about the efficacy of this approach. As patient concern about steroid-induced side-effects increased, it seemed that Europeans were moving to a mid-Atlantic position, but case discussions at recent meetings have highlighted persistent differences in the initial treatment of a common condition. This is in spite of guidelines published on both sides of the Atlantic within the past 18 months (1,2), whose recommendations are not that dissimilar. They are, after all, based on the same evidence. The essence of the argument between the continents comes down to differences in emphasis placed on the speed and the degree of response.