scholarly journals Case Report on Ulcerative Colitis in 16 year girl

2020 ◽  
pp. 287-290
Author(s):  
MD.Salma MD.Salma ◽  
Y.Siva Y.Siva ◽  
, J.Bhargava Narendra , J.Bhargava Narendra
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Presentation ◽  
Severe Disease ◽  
Topical Therapy ◽  
Calcineurin Inhibitors ◽  
Pharmacologic Therapy ◽  
Inflammatory Disorder ◽  
Aminosalicylic Acid ◽  
Intravenous Steroids ◽  
Factor Α

Ulcerative colitis (UC) is a chronic idiopathic inflammatory disorder that involves any part of the colon starting in the rectum in a continuous fashion presenting typically with symptoms such as bloody diarrhea, abdominal pain, and rectal urgency.The clinical presentation of the disease usually dictates the choice of pharmacologic therapy, where the goal is to first induce remission and then maintain a corticosteroid-free remission. UC is diagnosed based on clinical presentation and endoscopic evidence of inflammation in the colon starting in the rectum and extending proximally in the colon. The choice of treatment depends on severity, localization and the course of the disease. For proctitis, topical therapy with 5-aminosalicylic acid (5-ASA) compounds is used. More extensive or severe disease should be treated with oral and local 5-ASA compounds and corticosteroids to induce remission. Patients who do not respond to this treatment require hospitalization. Intravenous steroids or, when refractory, calcineurin inhibitors (cyclosporine, tacrolimus), tumor necrosis factor-α antibodies (infliximab) or immunomodulators (azathioprine, 6-mercaptopurine) are then called for. Indications for emergency surgery include refractory toxic megacolon, perforation, and continuous severe colorectal bleeding.

Ulcerative colitis

2020 ◽  
pp. 2937-2950
Author(s):  
Jeremy Sanderson ◽  
Peter Irving
Keyword(s):  
Ulcerative Colitis ◽  
Severe Disease ◽  
Stool Culture ◽  
Volume Depletion ◽  
Mild Disease ◽  
Gradual Onset ◽  
Moderate Disease ◽  
Variable Extent ◽  
Maintenance Of Remission ◽  
Intravenous Steroids

Ulcerative colitis is a chronic relapsing and remitting disease in which chronic inflammation affects the rectum and extends proximally to a variable extent. The precise aetiology remains unknown but involves an interplay between reduced diversity in the gut microbiota and a genetically dysregulated gut immune system and epithelial barrier. Typical presentation of mild or moderate disease is with a gradual onset of symptoms including diarrhoea, rectal bleeding, and the passage of mucus. Severe disease is characterized by anorexia, nausea, weight loss, and severe diarrhoea, with the patient likely to look unwell with fever, tachycardia, and other signs of volume depletion, and the abdomen may be distended and tympanitic, with reduced bowel sounds and marked colonic tenderness. Diagnosis is usually made on the basis of exclusion of infective colitis by stool culture and the finding of typical diffuse inflammation in the rectum and above at sigmoidoscopy. Management requires rapid control of symptoms with induction therapy followed by maintenance of remission. Mild disease is typically treated with 5-aminosalicyclic acid delivered both orally and by enema, and moderate disease by 5-aminosalicyclic acid and steroids. Patients with severe disease require hospital admission, intravenous steroids, and daily review by both a physician and a surgeon experienced in the management of ulcerative colitis. Ciclosporin or infliximab are used as rescue therapies for steroid-resistant acute severe ulcerative colitis, but colectomy should not be delayed when this is required. Maintenance therapy with immunomodulators and biological therapies are both effective at maintaining remission, and several new biologicals are in clinical trials.

scholarly journals Anti-proteinase 3 antineutrophil cytoplasmic antibody reflects disease activity and predicts the response to steroid therapy in ulcerative colitis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuki Aoyama ◽  
Tomoki Inaba ◽  
Sakuma Takahashi ◽  
Hisae Yasuhara ◽  
Sakiko Hiraoka ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Disease Activity ◽  
Steroid Therapy ◽  
Induction Therapy ◽  
Clinical Remission ◽  
Severe Disease ◽  
Active Phase ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Proteinase 3 ◽  
Aminosalicylic Acid

Abstract Background Serum anti-proteinase 3 antineutrophil cytoplasmic antibody (PR3-ANCA) is a disease-specific antibody against granulomatosis with polyangiitis. PR3-ANCA is a useful serological marker for disease severity in ulcerative colitis (UC). The purpose of this study was to investigate whether PR3-ANCA levels could also predict the success of induction therapy and to compare its performance against other markers, including serum CRP and fecal hemoglobin. Methods This was a multicenter retrospective study. In total, 159 patients with active-phase UC underwent colonoscopy. Disease activity was measured using the Mayo endoscopic subscore (MES). PR3-ANCA positivity and the response to induction therapy, either 5-aminosalicylic acid or steroid, were assessed. PR3-ANCA, CRP, and fecal hemoglobin were measured during the active phase, and during clinical remission. Results Eighty-five (53.5%) of 159 patients with active UC were positive for PR3-ANCA. PR3-ANCA titers were significantly higher in the group of patients with MES 3 compared to patients with MES 1 (P = 0.002) or MES 2 (P = 0.035). Steroid therapy was administered to 56 patients with a median partial Mayo score of 7 (5–9), which is equivalent to moderate-to-severe disease activity. PR3-ANCA positivity of non-responders to steroid therapy was significantly higher than that of responders (71.9% vs, 41.7%, P = 0.030), whereas CRP and fecal hemoglobin were not predictive of steroid response. Multivariate analysis demonstrated that PR3-ANCA positivity was associated with non-response to steroid therapy (odds ratio 5.19; 95% confidence interval, 1.54–17.5; P = 0.008). Of the 37 patients treated to clinical remission who were also positive for PR3-ANCA during the active phase, 27 had an MES of ≥ 1, and 10 patients had an MES of 0. In clinical remission, the proportion of patients with MES 0 in 17 patients whose PR3-ANCA became negative was significantly higher than that in 20 patients whose PR3-ANCA remained positive (47.1% vs. 10.0%, P = 0.023). Conclusions PR3-ANCA not only serves as a marker of disease activity, but also predicts the failure of steroid therapy in moderate-to-severe UC. Trial registration: This study was retrospectively registered in the UMIN Clinical Trials Registry System (000039174) on January 16, 2020.

scholarly journals A case report of ulcerative colitis patient who responded to the topical therapy with the combination of 5-aminosalicylic acid and corticosteroid

2004 ◽  
Vol 65 (2) ◽  
pp. 92-93
Author(s):  
Yutaro Kubota ◽  
Yoshiaki Takeuchi ◽  
Minil Kim ◽  
Yousuke Kumekawa ◽  
Kenichi Morikawa ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Case Report ◽  
Ulcerative Colitis Patient ◽  
Topical Therapy ◽  
Aminosalicylic Acid ◽  
Colitis Patient

scholarly journals Therapeutic Management in Ulcerative Colitis

2018 ◽  
Vol 15 (6) ◽  
pp. 61-72 ◽  
Author(s):  
Roxana Călin ◽  
Petruţ Nuţă
Keyword(s):  
Ulcerative Colitis ◽  
Disease Severity ◽  
Rectal Bleeding ◽  
Combined Therapy ◽  
Severe Disease ◽  
Typical Feature ◽  
Immunosuppressive Drugs ◽  
Inflammatory Disorder ◽  
Severe Ulcerative Colitis ◽  
Early Introduction

AbstractUlcerative colitis is a chronic idiopathic inflammatory disorder of the colon, characterized by a diffuse continuous superficial inflammation that always begins within the rectum and affects the proximal colon to a varying extent. One typical feature of the disease is that it does not involve the small intestine. A small percentage of patientsmay present a superficial inflammation of the terminal ileum. Clinically the disease is associated with rectal bleeding and urgency, tenesmus, abdominal pain and diarrhea. In the assessment of the disease severity, various factors are used, including the frequency of bowel movements, rectal bleeding, laboratory tests, endoscopic extension and appearance and patient’s quality of life.The treatment of ulcerative colitis is adapted to the disease severity and to the individual patient, no treatment being universally effective. Treatment decisions should be based on disease activity (mild, moderate, severe) and distribution (proctitis, left-sided, extensive colitis) If mild to moderate inflammation is limited to the rectum and for left-sided colitis, the mainstay on the treatment are 5-aminosalicylates, which are highly effective as a topical treatment (suppositories, enemas, foams). Corticosteroids are indicated in patients with more severe disease, and in cases where mesalamine has failed in inducing remission.For extensive mild to moderate ulcerative colitis, therapy recommendation consists of a combined therapy using oral and topical 5-ASA, which proved to be superior to single use of either. Use of systemic corticosteroids should be considered earlier for patients with extensive colitis and/or treatment failure. For patients with severe ulcerative colitis, hospitalization is generally required. In these cases, steroid therapy is still the gold standard. If there is no improvement in the first 72 hours after the initiation of treatment or symptoms are worsening, second-line conventional therapy must be attempted or proctocolectomymay be considered. In steroid-refractory patients, as well as in patients with severe ulcerative colitis, early introduction of immunosuppressive drugs may be effective during severe episodes, and for the prevention of complications, such as toxic megacolon. Without doubt, the introduction of anti-TNF antibodies have improved the therapeutic options available for patients with ulcerative colitis. But, there still is a substantial amount of patients not responding to anti-TNF antibodies or experiencing a secondary loss of response. Fortunately, for these cases, new classes of drugs have been developed and have been evaluated in early clinical trials.To illustrate the heterogeneity of cases of ulcerative colitis, we present three particular situations.

scholarly journals Factors associated with the persistence of oral 5-aminosalicylic acid monotherapy in ulcerative colitis: a nationwide Norwegian cohort study

2021 ◽  
Vol 14 ◽  
pp. 175628482110217
Author(s):  
Reidar Fossmark ◽  
Maya Olaisen ◽  
Tom Christian Martinsen ◽  
Hans Olav Melberg
Keyword(s):  
Ulcerative Colitis ◽  
Severe Disease ◽  
High Dose ◽  
Prescription Database ◽  
Aminosalicylic Acid ◽  
Dose Treatment ◽  
Factors Associated ◽  
High Dose Treatment ◽  
Combining Data ◽  
National Cohort

Background: Oral 5-aminosalicylic acid (5-ASA) is the mainstay treatment of ulcerative colitis (UC) and therapy with oral 5-ASA is associated with beneficial outcomes. We have examined factors associated with the persistence of oral 5-ASA treatment in a national cohort of UC patients. Methods: Patients with newly diagnosed UC from 2010 to 2014 using oral 5-ASA monotherapy were identified by combining data from the Norwegian Patient Registry and the Norwegian Prescription Database. The median follow-up time was 1029 days. Drug persistence was defined as duration of oral 5-ASA preparation as monotherapy. Non-persistence of a oral 5-ASA preparation as monotherapy was defined as stopping oral 5-ASA, initiation of any further anti-inflammatory treatment including a course of glucocorticoids and a change to another oral 5-ASA preparation. Drug persistence was analyzed using the Kaplan–Meier method and influence of covariates on drug persistence was analyzed with the Cox proportional hazard model. Results: A total of 3421 patients were identified. The overall median 5-ASA drug persistence was 179 days. In univariate analyses, persistence was associated with preparation type and high-dose treatment, while oral glucocorticoid use or hospitalization around the start of oral 5-ASA were associated with shorter 5-ASA persistence. In multivariate analyses, oral glucocorticoids [HR 1.67 (1.54–1.80), p < 0.005] and hospitalization around start of 5-ASA [HR 1.23 (1.14–1.34), p < 0.005] were associated with non-persistence, whereas high dose (⩾3 g/day) 5-ASA was associated with longer persistence [HR 0.68 (0.65–0.71), p < 0.005]. Conclusion: High-dose treatment with oral 5-ASA was associated with longer persistence of oral 5-ASA monotherapy, whereas the presence of factors indicating more severe disease around initiation of 5-ASA monotherapy was associated with a shorter persistence.

Overview of Biological Therapy in Ulcerative Colitis: Current and Future Directions

2015 ◽  
Vol 24 (2) ◽  
pp. 203-213 ◽  
Author(s):  
Federica Furfaro ◽  
Cristina Bezzio ◽  
Sandro Ardizzone ◽  
Alessandro Massari ◽  
Roberto De Franchis ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Immunosuppressive Agents ◽  
Mucosal Healing ◽  
Aminosalicylic Acid ◽  
Proinflammatory Mediators ◽  
Experimental Drugs ◽  
New Treatments ◽  
Aggressive Clinical Course ◽  
Near Future

The treatment of ulcerative colitis (UC) has changed over the last decade. It is extremely important to optimize the therapies which are available nowadays and commonly used in daily clinical practice, as well as to stimulate the search for more powerful drugs for the induction and maintenance of sustained and durable remission, thus preventing further complications. Therefore, it is mandatory to identify the patients' prognostic variables associated with an aggressive clinical course and to test the most potent therapies accordingly.To date, the conventional therapeutic approach based on corticosteroids, salicylates (sulfasalazine, 5-aminosalicylic acid) or immunosuppressive agents is commonly used as a first step to induce and to maintain remission. However, in recent years, knowledge of new pathogenetic mechanisms of ulcerative colitis have allowed us to find new therapeutic targets leading to the development of new treatments that directly target proinflammatory mediators, such as TNF-alpha, cytokines, membrane migration agents, cellular therapies.The aim of this review is to provide the most significant data regarding the therapeutic role of drugs in UC and to give an overview of biological and experimental drugs that will become available in the near future. In particular, we will analyse the role of these drugs in the treatment of acute flare and maintenance of UC, as well as its importance in mucosal healing and in treating patients at a high risk of relapse.

scholarly journals Inflammatory Bowel Disease: An Overview of Immune Mechanisms and Biological Treatments

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
Bruno Rafael Ramos de Mattos ◽  
Maellin Pereira Gracindo Garcia ◽  
Julia Bier Nogueira ◽  
Lisiery Negrini Paiatto ◽  
Cassia Galdino Albuquerque ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Severe Disease ◽  
Biological Therapies ◽  
Promising Alternative ◽  
Biological Treatments ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
And Behavior

Inflammatory bowel diseases (IBD) are characterized by chronic inflammation of the intestinal tract associated with an imbalance of the intestinal microbiota. Crohn’s disease (CD) and ulcerative colitis (UC) are the most widely known types of IBD and have been the focus of attention due to their increasing incidence. Recent studies have pointed out genes associated with IBD susceptibility that, together with environment factors, may contribute to the outcome of the disease. In ulcerative colitis, there are several therapies available, depending on the stage of the disease. Aminosalicylates, corticosteroids, and cyclosporine are used to treat mild, moderate, and severe disease, respectively. In Crohn’s disease, drug choices are dependent on both location and behavior of the disease. Nowadays, advances in treatments for IBD have included biological therapies, based mainly on monoclonal antibodies or fusion proteins, such as anti-TNF drugs. Notwithstanding the high cost involved, these biological therapies show a high index of remission, enabling a significant reduction in cases of surgery and hospitalization. Furthermore, migration inhibitors and new cytokine blockers are also a promising alternative for treating patients with IBD. In this review, an analysis of literature data on biological treatments for IBD is approached, with the main focus on therapies based on emerging recombinant biomolecules.

Surgical treatment of rapidly advancing active ulcerative colitis: a case report

Nowa Medycyna ◽  
2018 ◽  
Vol 25 (3) ◽  
Author(s):  
Sławomir Glinkowski ◽  
Daria Marcinkowska
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Presentation ◽  
Histopathological Examination ◽  
Vacuum Therapy ◽  
Active Ulcerative Colitis ◽  
Packed Red Blood Cells ◽  
Surgical Department ◽  
Bacterial Aetiology ◽  
Good General Condition ◽  
Impaired Immune Response

Ulcerative colitis is an inflammatory bowel disease with various clinical presentation. Due to an impaired immune response, diffuse inflammation develops in the intestinal tissue, which leads to bleeding and diarrhoea. The basis for diagnosis is the clinical presentation and the result of colonoscopy which confirms the presence of inflammatory lesions in the colon. The authors present the case of a patient admitted to their department following two previous hospitalisations at other centres who was suffering from active ulcerative colitis. After bacterial aetiology of the disease was excluded and conservative treatment was attempted at a gastroenterology ward, the patient was referred to a surgical department. During the previous hospitalisation colonoscopy was performed in which a lesion was observed in the splenic flexure, which precluded the visualisation of the further part of the colon. A colonoscopy performed at the surgical department did not confirm the presence of that lesion; however, it did reveal multiple pseudopolyps. Due to rapidly progressing cachexia and anaemia and a lack of improvement following attempted pharmacological treatment, a decision was made to perform an urgent colectomy with end ileostomy. After a week-long preparation of the patient (parenteral nutrition, packed red blood cells transfusion), pancolectomy was performed. Histopathological examination confirmed acute phase ulcerative colitis. In the postoperative period massive wound infection developed, which was treated for 14 days with vacuum therapy (VAC). The patient was treated for 30 days at the surgical department. He was discharged in a good general condition and instructed to report to his outpatient care centre.

scholarly journals Efficacy of 5-Aminosalicylic Acid Enemas in the Treatment of Distal Ulcerative Colitis

1990 ◽  
Vol 4 (7) ◽  
pp. 468-471 ◽  
Author(s):  
MG Robinson ◽  
DL Decktor
Keyword(s):  
Ulcerative Colitis ◽  
Disease Activity ◽  
Activity Index ◽  
Disease Activity Index ◽  
First Episode ◽  
High Dose ◽  
Aminosalicylic Acid ◽  
Open Label ◽  
Distal Ulcerative Colitis ◽  
The Mean

The efficacy of 4 g 5-aminosalicylic acid (5-ASA, mesalamine) enemas was assessed in 666 patients with distal ulcerative colitis. Patients were enrolled in an open-label compassionate use program. One 4 g 5-ASA enema was administered each night for a period of four weeks and the disease activity index was assessed at baseline and on days 14 and 28. On days 14 and 28, 78.0% and 88.1% of patients, respectively, demonstrated an improvement in disease activity index. The mean decline in disease activity index on day 14 was 40.7% (P=0.0001) and on day 28 it was 55.4% (P=0.0001). Efficacy was similar whether the disease was confined to or extended beyond 30 cm from the anus. There was no difference in efficacy in patients suffering their first episode of disease compared to patients suffering subsequent attacks. In conclusion, high dose 5-ASA enemas are a highly effective treatment for distal ulcerative colitis.

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