Sagar Garud; Mark A. Peppercorn
Authors and Disclosures
Ther Adv Gastroenterol. 2009;2(2):99-108. © 2009 Sage Publications, Inc.
Abstract and Introduction
Abstract
Ulcerative colitis (UC) is a disease of unknown etiology characterized by inflammation of the mucosa and occasionally the submucosa of the colon. Conventional drug therapy for UC involves use of aminosalicylates, corticosteroids, azathioprine/6-mercaptopurine, cyclosporine and anti-tumor necrosis factor therapy. Alternative therapies include probiotics, nicotine and fish oil. Drugs like tacrolimus, rosiglitazone and Trichuris suis ova are being evaluated for use in UC patients. With the new biologic agents, new treatment options for UC continue to evolve. In this article we will discuss the conventional drugs, the alternative therapies and the management strategies according to the severity and extent of UC.
Introduction
Ulcerative colitis (UC) is a disease of unknown etiology characterized by inflammation of the mucosa and occasionally the submucosa of the colon. A persistent and inappropriate immunologic response to gut luminal antigens is thought to be the reason for this inflammation. Absence of enteric parasites in the developed world and defective mucosal defence mechanisms are some of the hypotheses behind the pathogenesis. The incidence of UC in North America ranges from 2.2 to 14.3 cases per 100,000 person years. The prevalence of UC ranges from 37 to 246 per 100,000 persons [Loftus, 2004]. UC can present at any age, although the peak incidence occurs between the ages of 15 and 30 years.
The following terms are used to describe the degree of involvement of the colon and management depends on the extent and severity of the disease:
* Ulcerative proctitis refers to disease limited to the rectum.
* Distal colitis or proctosigmoiditis refers to disease extending to the mid-sigmoid colon, usually reachable by a 60 cm flexible sigmoidoscope.
* Left-sided colitis refers to disease extending to but not beyond the splenic flexure.
* Extensive colitis is defined as disease that extends beyond the splenic flexure but not as far as the cecum.
* Pancolitis is used when the inflammatory process extends to the cecum.
Patients can also be classified as having mild, moderate or severe disease as follows:
* Mild disease: Patients with mild disease usually present with intermittent rectal bleeding associated with the passage of mucus, and mild diarrhea with fewer than four small loose stools per day. Mild crampy pain, tenesmus, and periods of constipation are also common. Severe abdominal pain, profuse bleeding, fever, and weight loss are not the symptoms and signs of mild disease.
* Moderate disease: characterized by frequent loose, bloody stools (up to 10 per day), mild anemia not requiring blood transfusions, abdominal pain that is not severe, and low-grade fever.
* Severe disease: These patients present with frequent loose stools (>10 per day), severe cramps, high-grade fever and bleeding often requiring blood transfusion. They may also have rapid weight loss.
In this article, we will discuss conventional drugs, alternative therapies and management strategies according to the severity and extent of UC.
Authors and Disclosures
Ther Adv Gastroenterol. 2009;2(2):99-108. © 2009 Sage Publications, Inc.
Abstract and Introduction
Abstract
Ulcerative colitis (UC) is a disease of unknown etiology characterized by inflammation of the mucosa and occasionally the submucosa of the colon. Conventional drug therapy for UC involves use of aminosalicylates, corticosteroids, azathioprine/6-mercaptopurine, cyclosporine and anti-tumor necrosis factor therapy. Alternative therapies include probiotics, nicotine and fish oil. Drugs like tacrolimus, rosiglitazone and Trichuris suis ova are being evaluated for use in UC patients. With the new biologic agents, new treatment options for UC continue to evolve. In this article we will discuss the conventional drugs, the alternative therapies and the management strategies according to the severity and extent of UC.
Introduction
Ulcerative colitis (UC) is a disease of unknown etiology characterized by inflammation of the mucosa and occasionally the submucosa of the colon. A persistent and inappropriate immunologic response to gut luminal antigens is thought to be the reason for this inflammation. Absence of enteric parasites in the developed world and defective mucosal defence mechanisms are some of the hypotheses behind the pathogenesis. The incidence of UC in North America ranges from 2.2 to 14.3 cases per 100,000 person years. The prevalence of UC ranges from 37 to 246 per 100,000 persons [Loftus, 2004]. UC can present at any age, although the peak incidence occurs between the ages of 15 and 30 years.
The following terms are used to describe the degree of involvement of the colon and management depends on the extent and severity of the disease:
* Ulcerative proctitis refers to disease limited to the rectum.
* Distal colitis or proctosigmoiditis refers to disease extending to the mid-sigmoid colon, usually reachable by a 60 cm flexible sigmoidoscope.
* Left-sided colitis refers to disease extending to but not beyond the splenic flexure.
* Extensive colitis is defined as disease that extends beyond the splenic flexure but not as far as the cecum.
* Pancolitis is used when the inflammatory process extends to the cecum.
Patients can also be classified as having mild, moderate or severe disease as follows:
* Mild disease: Patients with mild disease usually present with intermittent rectal bleeding associated with the passage of mucus, and mild diarrhea with fewer than four small loose stools per day. Mild crampy pain, tenesmus, and periods of constipation are also common. Severe abdominal pain, profuse bleeding, fever, and weight loss are not the symptoms and signs of mild disease.
* Moderate disease: characterized by frequent loose, bloody stools (up to 10 per day), mild anemia not requiring blood transfusions, abdominal pain that is not severe, and low-grade fever.
* Severe disease: These patients present with frequent loose stools (>10 per day), severe cramps, high-grade fever and bleeding often requiring blood transfusion. They may also have rapid weight loss.
In this article, we will discuss conventional drugs, alternative therapies and management strategies according to the severity and extent of UC.