scholarly journals Management of Acute Severe Colitis in the Era of Biologicals and Small Molecules

2019 ◽  
Vol 8 (12) ◽  
pp. 2169
Author(s):  
Christine Verdon ◽  
Talat Bessissow ◽  
Peter L. Lakatos
Keyword(s):  
Ulcerative Colitis ◽  
Small Molecules ◽  
Patient Monitoring ◽  
Treatment Options ◽  
Medical Emergency ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
New Treatment ◽  
Acute Severe Colitis ◽  
Severe Colitis

Acute severe ulcerative colitis (ASUC) is a medical emergency which occurs in about 20%–30% of patients with ulcerative colitis during their lifetime, and does carry a mortality risk of 1%. The management of inflammatory bowel diseases has evolved with changes in objective patient monitoring, as well as the availability of new treatment options with the development of new biological and small molecules; however, data is limited regarding their use in the context of ASUC. This review aims to discuss the emerging data regarding biologicals and small molecules therapies in the context of ASUC.

scholarly journals Pregnancy-Onset Acute Severe Colitis after in vitro Fertilization Embryo Transfer

2020 ◽  
Vol 14 (3) ◽  
pp. 477-482
Author(s):  
Dora Grgić ◽  
Silvija Čuković Čavka ◽  
Vesna Elveđi Gašparović ◽  
Nikša Turk ◽  
Marko Brinar ◽  
...  
Keyword(s):  
In Vitro Fertilization ◽  
Biologic Therapy ◽  
Late Pregnancy ◽  
Vitro Fertilization ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Acute Severe Colitis ◽  
Severe Colitis ◽  
In Pregnancy

Inflammatory bowel diseases (IBD) usually affect women in their fertile years and, therefore, have implications for their fertility and pregnancy. The presence of IBD during pregnancy has been shown to adversely affect pregnancy outcomes, and increased rates of preterm delivery and of spontaneous abortion have been reported. An onset of acute severe colitis in pregnancy has rarely been seen. We present the case of a 42-year-old woman who conceived after 9 attempts of in vitro fertilization and whose pregnancy was the result of a donated oocyte. Shortly after conception, she was diagnosed with severe active ulcerative colitis, and biologic therapy was introduced in the 28th week of pregnancy. Although therapy for IBD in pregnancy is considered safe for most drugs, this was not very well known in 2015. We also consider our case exceptional because we now have a 5-year follow-up of our patient and her child after having begun biologic therapy during late pregnancy.

scholarly journals Recent advances and emerging therapies in the non-surgical management of ulcerative colitis

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1207 ◽  
Author(s):  
Jan Wehkamp ◽  
Eduard F. Stange
Keyword(s):  
Ulcerative Colitis ◽  
Small Molecules ◽  
Primary Response ◽  
Emerging Therapies ◽  
Novel Drugs ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Established Role ◽  
New Algorithms ◽  
Necrosis Factor

The so-called “biologicals” (monoclonal antibodies to various inflammatory targets like tumor necrosis factor or integrins) have revolutionized the treatment of inflammatory bowel diseases. In ulcerative colitis, they have an established role in inducing remission in steroid-refractory disease and, thereafter, maintaining remission with or without azathioprine. Nevertheless, their limitations are also obvious: lack of primary response or loss of response during maintenance as well as various, in part severe, side effects. The latter are less frequent in anti-integrin treatment, but efficacy, especially during induction, is delayed. New antibodies as well as small molecules have also demonstrated clinical efficacy and are soon to be licensed for ulcerative colitis. None of these novel drugs seems to be much more effective overall than the competition, but they provide new options in otherwise refractory patients. This increasing complexity requires new algorithms, but it is still premature to outline each drug’s role in future treatment paradigms.

Managing IBD therapy during pregnancy demands a multidisciplinary approach

2021 ◽  
Vol 75 (2) ◽  
pp. 149-158
Author(s):  
Filip Marek ◽  
Radoslav Hrivnák ◽  
Ivo Rovný ◽  
Petr Jabandžiev ◽  
Karolína Poredská ◽  
...  
Keyword(s):  
Best Practice ◽  
Multidisciplinary Approach ◽  
Conservative Therapy ◽  
Perianal Abscess ◽  
Multidisciplinary Cooperation ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Acute Severe Colitis ◽  
Severe Colitis ◽  
Chronic Inflammatory Bowel

Crohn’s disease and ulcerative colitis are both chronic inflammatory bowel diseases (IBD). This article summarizes current best practice in treating pregnant patients with IBD, ranging from conservative therapy to endoscopy and imaging methods, including a description of surgical therapy indications. Female patients with IBD should ideally plan their pregnancies for when their disease is in remission. Patients in remission may also have complications during pregnancy, however the risk of complications is lower than in patients with active disease. Any chronic medications they were on before becoming pregnant (with the exception of teratogenic methotrexate) should remain unchanged. According to the current literature, pregnancy does not itself complicate the course of IBD. In cases of a severe relapse or an occurrence of complications in these patients, careful multidisciplinary cooperation is required, especially between the gastroenterologist, surgeon, radiologist, and gynaecologist. Surgical treatment is required only in cases of acute complications of IBD (such as acute severe colitis resistant to medical therapy, perianal abscess, and complications of IBD in the sense of such acute abdomen events as perforations, ileus due to a stenosis, or massive haemorrhage).

scholarly journals New treatment options for inflammatory bowel diseases

2018 ◽  
Vol 53 (5) ◽  
pp. 585-590 ◽  
Author(s):  
Bram Verstockt ◽  
Marc Ferrante ◽  
Séverine Vermeire ◽  
Gert Van Assche
Keyword(s):  
Inflammatory Bowel Diseases ◽  
Treatment Options ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
New Treatment

scholarly journals Predicting outcome in acute severe colitis – controversies in clinical practice in 2021

2021 ◽  
Author(s):  
Vipin Gupta ◽  
Waled Mohsen ◽  
Thomas P Chapman ◽  
Jack Satsangi
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Practice ◽  
Medical Emergency ◽  
Prediction Of Outcome ◽  
Predicting Outcome ◽  
Clinical Indices ◽  
Considerable Morbidity ◽  
Acute Severe Colitis ◽  
The Impact ◽  
Severe Colitis

Abstract Acute severe ulcerative colitis (ASUC) remains a common medical emergency, with 25% of patients with ulcerative colitis experiencing at least one event in their disease course. Despite advances in medical therapy, ASUC continues to be associated with considerable morbidity and mortality, with up to 30% of patients requiring colectomy during initial admission. Our aim was to review the current controversies and recent progress in risk stratification, prediction of outcome, and personalisation of care in ASUC. We re-assess the use of Truelove and Witts’ criteria, serum biomarkers and the use of composite clinical indices in current clinical practice. We explore the potential for endoscopic prediction using defined validated indices for accurate and early prognostication, and the need to define outcome. We also consider the impact of the current COVID-19 pandemic. Finally, we discuss the current research agenda including the application of new and emerging biomarkers coupled with multi-omics and the implications in management and optimisation of outcome.

Features of the complex treatment of ulcerative colitis in clinical practice

2020 ◽  
pp. 6-11
Author(s):  
Svetlana Svetlana ◽  
Mikhail Klimentov ◽  
Olga Neganova ◽  
Alina Nazmieva ◽  
Anastasiya Kochurova
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Practice ◽  
Statistical Study ◽  
Age Groups ◽  
Length Of Hospital Stay ◽  
Unknown Etiology ◽  
Number Of Patients ◽  
First Republic ◽  
Bowel Diseases ◽  
Inflammatory Bowel

Nowadays there are certain difficulties in the early diagnosis of ulcerative colitis, proceeding with minimal intestinal symptoms. The etiology of the disease remains unclear to this day; there is no exact information about the prevalence of the disease due to the large number of latent forms and the low number of patients seeking medical help. This article presents the results of a retrospective analysis of the incidence of ulcerative colitis in the coloproctology department of the First Republic Clinical Hospital of Izhevsk. The study was conducted to assess the frequency of occurrence and determine the internal picture of ulcerative colitis. To achieve this goal, we selected 34 patients with ulcerative colitis. A statistical study was conducted on the following criteria: gender composition, age groups, forms of the disease, localization, complications, and main complaints. The length of hospital stay often was not more than 20 days. The literature on this pathology was also studied and presented in the form of a theoretical basis, which consisted of the determination and etiology of inflammatory bowel diseases. Due to the unknown etiology, insufficiently studied pathogenesis, difficult differential diagnosis with other intestinal diseases and insufficiently perfect treatment methods, there are a large number of unresolved problems in the field of ulcerative colitis. That is why, in this article we tried to reveal the problem of the features of the course and complex therapy of that disease in clinical practice.

Thrombosis in IBD in the Era of JAK Inhibition

2020 ◽  
Vol 22 (1) ◽  
pp. 126-136
Author(s):  
Virginia Solitano ◽  
Gionata Fiorino ◽  
Ferdinando D’Amico ◽  
Laurent Peyrin-Biroulet ◽  
Silvio Danese
Keyword(s):  
Small Molecules ◽  
Arterial Thrombosis ◽  
Protective Role ◽  
Jak Inhibitors ◽  
Thrombotic Risk ◽  
Increased Risk ◽  
Bowel Diseases ◽  
Thrombotic Complications ◽  
Inflammatory Bowel ◽  
Inflammatory Effect

: Patients with inflammatory bowel diseases (IBD) have an increased risk of thrombosis. The interaction between inflammation and coagulation has been extensively studied. It is well-known that some drugs can influence the haemostatic system, but several concerns on the association between therapies and increased risk of thrombosis remain open. While biologics seem to have a protective role against thrombosis via their anti-inflammatory effect, some concerns about an increased risk of thrombosis with JAK inhibitors have been raised. We conducted a literature review to assess the association between biologics/small molecules and venous/arterial thrombotic complications. An increased risk of venous and arterial thrombosis was found in patients treated with corticosteroids, whereas anti-TNF were considered protective agents. No thromboembolic adverse event was reported with vedolizumab and ustekinumab. In addition, thromboembolic events rarely occurred in patients with ulcerative colitis (UC) after therapy with tofacitinib. The overall risk of both venous and arterial thrombosis was not increased based on the available evidence. Finally, in the era of JAK inhibitors, treatment should be individualized by evaluating the pre-existing potential thrombotic risk balanced with the intrinsic risk of the medication used.

Curative Ayurvedic approach to Ulcerative colitis - A Case Report

2016 ◽  
Vol 1 (2) ◽  
Author(s):  
Dr. Sumedh Wasnik ◽  
Anita Ghodke ◽  
Vaibhav Sulakhe
Keyword(s):  
Ulcerative Colitis ◽  
Weight Loss ◽  
Immune Suppression ◽  
Inflammatory Bowel Diseases ◽  
Life Style ◽  
Intravenous Fluids ◽  
Genetic Origin ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Difficult Issue

Westernization and today’s changing life style is resulting in various health problems like Inflammatory Bowel diseases, which is a common entity encountered in surgical practise. Ulcerative colitis is the most common among them. Though it is believed to have auto immune and genetic origin, today’s life style, environment, diet and stress plays an important role in aetiology. The disease is prevalent in middle aged western and northern people characterised by abdominal pain with bloody diarrhoea, weight loss, anaemia and general debility. This condition has remissions and exacerbations. One should always keep in mind that inflammatory bowel diseases can have anorectal manifestations. Diagnosis is made on the basis of symptoms, stool exam. and endoscopy. Management is symptomatic i.e. antibiotics, anti-inflammatory, anti-spasmodic, multivitamins, immune suppression and if required admission, intravenous fluids. if no response colectomy. As such there is no satisfactory treatment till date, so it remains the difficult issue. Here we need to have an alternative, safe, convenient treatment. Ayurveda has an answer for such cases.

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