active disease protocol. 19. Patients with mildly active UC should be reassessed to determine response to induction therapy within 6 weeks. 20. Fecal microbiota transplantation (FMT) requires more study and clarification of treatment before use as a therapy for UC. 21. Complementary therapies such as probiotics and curcumin require further study with adequate power and clarification of end points. Recommendations 6. In patients with mildly active ulcerative proctitis, we recommend rectal 5-aminosalicylate therapies at a dose of 1 g/d for induction of remission (strong recommendation, high-quality evidence). 7. In patients with mildly active left-sided UC, we recommend rectal 5-aminosalicylate enemas at a dose of at least 1 g/d preferred over rectal steroids for induction of remission (strong recommendation, moderate quality of evidence). 8. In patients with mildly active left-sided UC, we suggest rectal 5-aminosalicylate enemas at a dose of at least 1 g/d combined with oral 5-aminosalicylate at a dose of at least 2 g/d compared with oral 5-aminosalicylate therapy alone for induction of remission (conditional recommendation, low quality of evidence). 9. In patients with mildly active left-sided UC who are intolerant or nonresponsive to oral and rectal 5-aminosalicylate (5-ASA) at appropriate doses (oral at least 2 g/d and rectal at least 1 g/d), we recommend oral budesonide multi-matrix (MMX) 9 mg/d for induction of remission (strong recommendation, moderate quality of evidence). 10. In patients with mildly active extensive UC, oral 5-ASA at a dose of at least 2 g/d is recommended to induce remission (strong recommendation, moderate quality of evidence). 11. In patients with UC of any extent who fail to respond to 5-ASA therapy, we recommend oral systemic corticosteroids to induce remission (strong recommendation, low quality of evidence). 12. In patients with mildly active UC who fail to reach remission with appropriately dosed 5-ASA (at least 2 g/d oral 5-ASA and/or at least 1 g/d rectal 5-ASA), we suggest against changing to an alternate 5-ASA formulation to induce remission. Alternative therapeutic classes should be considered (conditional recommendation, low quality of evidence). 13. In patients with mildly active UC of any extent, we suggest using a low dose (2–2.4 g/d) of 5-ASA compared with a higher dose (4.8 g/d), as there is no difference in the remission rate (conditional recommendation, very low quality of evidence). 14. In patients with mildly to moderately active UC not responding to oral 5-ASA, we recommend the addition of budesonide MMX 9 mg/d to induce remission (strong recommendation, moderate quality of evidence). 15. In patients with mildly to moderately active UC of any extent using 5-ASA to induce remission, we recommend either once-daily or more frequently dosed oral 5-ASA based on patient preference to optimize adherence, as efficacy and safety are no different (strong recommendation, moderate quality evidence). Summary of evidence A meta-analysis of 11 randomized controlled trials (RCTs) of patients with UC treated with 5-ASA for induction or maintenance demonstrated superiority of 5-ASAs in inducing remission compared with placebo (94). In this analysis, patients receiving 5-ASA were more likely to achieve remission. Only 60.3% of patients treated with 5-ASAs failed to reach remission compared with 80.2% of patients treated with placebo (risk ratio (RR), 0.79; confidence interval (CI), 0.73–85; P = 0.009; number