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Ulcerative colitis

Ulcerative colitis. Essentials of diagnosis: Bloody diarrhea Lower abdominal cramps & fecal urgency Anemia, low serum albumin Negative stool cultures Sigmoidoscopy is the key to diagnosis. Ulcerative colitis: Assessment of disease severity.

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Ulcerative colitis

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  1. Ulcerative colitis

  2. Essentials of diagnosis: • Bloody diarrhea • Lower abdominal cramps & fecal urgency • Anemia, low serum albumin • Negative stool cultures • Sigmoidoscopy is the key to diagnosis

  3. Ulcerative colitis: Assessment of disease severity

  4. Stomach Jejunum Ileum Colon    Sulfasalazine Olsalazine Meslamine pH sensitive Release Tablets Mesalamine Delayed Release Capsules 5-ASA derivatives in ulcerative colitis: site of absorption of major drugs

  5. Treatment of ulcerative colitis: • Proctitis: • Mesalamine suppositories, 500mg twice daily, or • Hydrocortisone foam, 90mg per rectum daily or • Hydrocortisone suppositories, 100mg per rectum daily • Proctosigmoiditis: • Meslamine enema, 4g per rectum daily, or • Hydrocortisone enema, 100mg per rectum daily

  6. Treatment of ulcerative colitis: • Extensive colitis: • Mild to moderate: • Sulfasalazine, 1.5-3g orally twice daily., or • Mesalamine tablets (delayed release), 2.4-4.8g/day, or • Balsalszide,2.25g three times a day • If no response after 2-4 weeks, add prednisone,20-40mg/d (taper by 5mg/week) • Severe: • Methylprednisolone, 48-60mg IV daily

  7. Distal colitis: • Drug of choice meslamine suppositoryIf patients fail to respond: • Increase the same topical agent twice daily • Combination treatment with a 5-ASA enema at bed-time and a corticosteroid enema or foam in the morning. • Combination of a topical agent with oral 5-ASA agent

  8. Distal colitis: • Early/ frequent relapse: • Maintenance- mesalamine supposositories (500mg/d) • -Oral 5-ASA agents

  9. Mild to moderate colitis: • 5-ASA derivatives • Sulfasalazine 500mg bd (along with folic acid 1mg/d) • Mesalamine 1g four times daily • Balsalazide 2.25g tid • Olsalazine 500mg bd • No improvement after 2-3 weeks: • Topical steroids • 5-ASA enemas • Oral steroids

  10. Severe colitis: • General: • Discontinue oral intake for 24-48hrs. • Total parenteral nutrition • Correct acid-base deficits,anemia • Treat C difficle infection if present.

  11. Severe colitis: • Steroids: • Methylprednisolone 48-64mg or hydrocortisone 300mg in 4 divided doses or continuous infusion • Can try ACTH infusion 120 units/24hr. • Cyclosporine IV 2-4mg/kg/d infusion • SURGICAL

  12. Fulminant colitis and toxic megacolon: • Broad spectrum antibiotics to cover anaerobes & Gram –ve bacteria • Surgery to prevent perforation • Maintanence of remission: • Chronic sulfasalazine, olsalazine, mesalamine.

  13. Refractory disease: • Mercaptopurine • Azathioprine • Transdermal nicotine • Infliximab

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