Treatment Algorithm for Mild and Moderate-to-Severe Ulcerative Colitis: An Update

Burri, Emanuel; Maillard, Michel H.; Schoepfer, Alain; Seibold, Frank; Assche, Gert Van; Rivière, Pauline; Laharie, David; Manz, Markus G.

doi:10.1159/000504092

Cited by 90 publications

(78 citation statements)

References 109 publications

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Section: Discussionmentioning

confidence: 99%

“…Generally, 5-ASA is the preferred first-line treatment for UC and oral steroids should be considered for patients who do not respond adequately to 5-ASA [4]. Patients with steroid dependent UC should be treated with an either azathioprine, 6-mercaptopurine, TNF-inhibitor or vedolizumab [4]. Regarding treatment for de novo UC after KT, no standard protocol has been established because of complexities arising from combined use of common IBD therapy and antirejection therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Histological findings MMF related colitis [5,8] Erosions, hyperemia, erythema, Eosinophils and plasma cells infiltrate, withered crypts, apoptotic bodies CMV infection [8] Patchy erythema, exudates, microerosions Enterocyte apoptosis, inclusion bodies de novo UC [4,16] Erythema, loss of normal vascular pattern, granularity, erosions, friability, bleeding, and ulcerations [14]. Nonetheless, several complications were observed.…”

Section: Endoscopic Findingsmentioning

confidence: 99%

“…However, the mechanism, treatment, and management of de novo IBD after solid organ transplantation remain under evaluation, with no standard criteria. An anti-tumor necrosis factor-α (TNF-α) therapy is known to one of options for a corticosteroid-dependent course of UC [4]. To date, there are only limited clinical experience regarding the use of anti TNF-α therapy in UC in KT recipients.…”

Section: Introductionmentioning

confidence: 99%

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De novo ulcerative colitis after kidney transplantation treated with infliximab

et al. 2021

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Diarrhea is a common complication in kidney transplant recipients. Common causes of diarrhea include infection, side effect from medication, rejection, and malignancy. A less common but important cause of diarrhea is de novo inflammatory bowel disease (IBD). This is unexpected, as these patients are already immunosuppressed. Herein, we present the case of a 45-year-old man with end-stage kidney disease because of focal segmental glomerulosclerosis who underwent preemptive kidney transplantation, with his mother as donor. His immunosuppressive regimen included methylprednisolone, mycophenolate mofetil, and tacrolimus. He had no episodes of graft dysfunction, rejection, or infectious events. Two and a half years post-transplantation, he developed bloody diarrhea. After excluding infections, colonoscopy was performed and revealed edematous mucosa and erythema with pigmentation, which are typical findings in ulcerative colitis. Despite therapy with 5-aminosalicylate and granulocyte monocyte apheresis, he presented with massive bloody diarrhea. We initiated infliximab, an anti-tumor necrosis factor-α (TNF-α) agent. He responded very well and achieved remission within 6 months after initiation of infliximab, while administration of the other immunosuppressants was maintained. His course was uneventful and no complications developed. Management of immunosuppressants for de novo IBD after organ transplantation is complicated, because treatment of IBD, graft function protection, and prevention of infection must be considered. Therefore, cooperation between transplantation physicians and gastroenterologists is essential during therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Endoscopic Findingsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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De novo ulcerative colitis after kidney transplantation treated with infliximab

et al. 2021

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“…Bei Unverträglichkeit von 5-ASA können Probiotika [24] zum Einsatz kommen. Sollte es dann einen Rückfall geben, der den neuerlichen Einsatz von Steroiden erforderlich macht, wird eine Remissionserhaltung mit Thiopurinen oder Biologika empfohlen [25].…”

Section: Remissionserhaltungunclassified

Medikamentöse Therapie der chronisch entzündlichen Darmerkrankungen (CED)

Morgenstern

Streetz

2020

Der Klinikarzt

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ZUSAMMENFASSUNGDie Therapie der chronisch entzündlichen Darmerkrankungen (CED) unterliegt insbesondere in den letzten 2 Jahrzehnten einem deutlichen Wandel. Steroide nehmen in der Behandlung der akuten Entzündung sowohl beim Morbus Crohn als auch der Colitis ulcerosa zwar immer noch einen wichtigen Platz ein, stellen jedoch keine langfristige Therapieoption dar.Eine Vielzahl neuer galenischer Formulierungen bekannter Medikamente, der Einsatz von Biologika und neuer kleinmolekularer Inhibitoren (mit weiteren Wirkstoffen in der Entwicklung) erweitern die therapeutischen Möglichkeiten erfreulicherweise und führen damit zu einer Verbesserung der Lebensqualität der Patienten.Die große Herausforderung für den Behandler ist neben der Wahl des geeigneten Medikaments zum richtigen Zeitpunkt, zunehmend auch ein zielgerichtetes Management der Therapie. Hierzu gehören Dosisanpassungen der Therapeutika, geeignete Ko-Medikationen und ein genaues Monitoring des Krankheitsverlaufs.

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Evolving Experimental Platforms to Evaluate Ulcerative Colitis

et al. 2022

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tissue thus altering tissue integrity, anatomy, and physiology subsequently affecting the overall health-related quality of life (HRQoL) of afflicted individuals. [1][2][3] It is estimated that the lifetime financial loss associated with the typical UC patient can be greater than $1 million/patient to cover direct and indirect medical expenses including treatment, hospitalizations, and general medical care. [3][4][5][6][7] As an example, vedolizumab and adalimumab treatment for UC had total direct medical costs of $100 022 and $151 133, respectively, per patient. [8] This number varies greatly depending upon the severity of the disease with a greater expense attributed to those exhibiting a poor clinical disposition. At the domestic level, the total cost to treat UC is estimated to be between $4-14 billion per year which seems to rise on an annual basis. [3,6,7] The specific etiological basis regarding the initiation and progression of UC is currently unknown. Physical manifestations of severe UC take the form of ulcerations affecting the mucosal lining, specifically along the length of the affected large intestine and rectum as depicted in Figure 1. These lesions contain an overabundant accumulation of innate and adaptive immune cells, including T cells, that promote an inflammatory environment Ulcerative colitis (UC) is a multifactorial disease defined by chronic intestinal inflammation with idiopathic origins. It has a predilection to affect the mucosal lining of the large intestines and rectum. Management of UC depends upon numerous factors that include disease pathogenesis and severity that are maintained via medical or surgical means. Chronic inflammation that is left untreated or managed poorly from a clinical stance can result in intestinal ulceration accompanied by resulting physiological dysfunction. End-stage UC is mediated by surgical intervention with the resection of diseased tissue. This can lead to numerous health-related quality of life issues but is considered a curative approach. Regimens to treat UC are ever evolving and find their basis within various platforms to evaluate and treat UC. Numerous modeling systems have been examined to delineate potential mechanisms of action. However, UC is a heterogenous disease spanning unknown genetic origins coupled with environmental factors that can influence disease outcomes and related treatment procedures. Unfortunately, there is no one-size-fits-all model to fully assess all facets of UC. Within the context of this review article, the utility of various approaches that have been employed to gain insight into different aspects of UC will be investigated.

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Treatment Algorithm for Mild and Moderate-to-Severe Ulcerative Colitis: An Update

Cited by 90 publications

References 109 publications

De novo ulcerative colitis after kidney transplantation treated with infliximab

De novo ulcerative colitis after kidney transplantation treated with infliximab

Medikamentöse Therapie der chronisch entzündlichen Darmerkrankungen (CED)

Evolving Experimental Platforms to Evaluate Ulcerative Colitis

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