Medical Management of Ulcerative Colitis

Abstract

Ulcerative colitis (UC) is a chronic and relapsing inflammation limited to the colonic mucosa and always involving the rectum with variable extension towards the cecum. The aim of medical treatment is to induce and maintain clinical remission. In contrast to Crohn’s disease for which a ‘top-down’ or ‘early aggressive’ therapy is discussed, in UC the concept of a step-up treatment is still valid. This step-up approach includes local or systemic administration of 5-aminosalicylic acid as first-line therapy followed by topical or systemic steroid administration as well as azathioprine, 6-mercaptopurine, cyclosporine, and more recently anti-tumor necrosis factor monoclonal antibodies as options in refractory or chronic active disease. Colectomy may be necessary if medical treatments are unsuccessful or if complications develop. The decision about the individual therapy of UC is dependent on both disease activity and on disease location. Different therapy strategies are applied in ulcerative proctitis, left-sided colitis, pancolitis and fulminant colitis as well as in chronic active disease and maintenance of remission. This overview presents important concepts in the treatment of UC based on the published guidelines.

Protective Effects of Kurozu and Kurozu Moromimatsu on Dextran Sulfate Sodium-Induced Experimental Colitis

“…The causes of UC are not well established, but multiple genetic factors [29], immune responses of the colon, intestinal flora, inflammatory cytokines [30,31], and oxidative stress [8,12] are all thought to influence its severity. At present, the disease is generally treated with anti-inflammatories, such as 5-aminosalicylic acid (5-SAS) and prednisolone [32]. However, dietary therapy would be desirable, particularly from the viewpoints of safety and long-term effect.…”

Review article: the role of anti‐TNF in the management of ulcerative colitis – past, present and future

“…Eliminating steroid use and aiming for endoscopic remission were not considered. The armamentarium for UC ranged from aminosalicylates for mild disease to IV steroids and calcineurin inhibitors for severe cases and treatment decisions were based mainly on disease severity . Abundant evidence exists supporting the use of aminosalicylates [5‐aminosalicylic acid (5‐ASA)] in mild to moderate UC for inducing remission.…”

“…Azathioprine (AZA) and mercaptopurine have been shown to be useful in steroid‐refractory patients. Cyclosporin is mainly reserved for severe patients after IV corticosteroids . A new class of drugs, anti‐tumour necrosis factor (TNF) biologics, has emerged over a decade ago, and were originally evaluated in Crohn's disease (CD).…”

Colonoscopic evaluation in ulcerative colitis

“…This term is also used for colitis that extends throughout the entire colon [4]. Mild-to-moderate extensive colitis is initially treated with 5-ASAs, while severe or refractory extensive colitis is treated with oral or intravenous corticosteroids or anti-tumor necrosis (anti-TNF) agents [14]. In mild-to-moderate disease, at least 2 grams of oral 5-ASAs and topical mesalazine should be used [10].…”