Ulcerative colitis
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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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  • Essentials of diagnosis:

  • Bloody diarrhea

  • Lower abdominal cramps & fecal urgency

  • Anemia, low serum albumin

  • Negative stool cultures

  • Sigmoidoscopy is the key to diagnosis



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


  • 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


  • 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


  • 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


  • Distal colitis:

  • Early/ frequent relapse:

  • Maintenance- mesalamine supposositories (500mg/d)

  • -Oral 5-ASA agents


  • 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


  • Severe colitis:

  • General:

  • Discontinue oral intake for 24-48hrs.

  • Total parenteral nutrition

  • Correct acid-base deficits,anemia

  • Treat C difficle infection if present.


  • 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


  • 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.



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