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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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Presentation Transcript
slide2

Essentials of diagnosis:

  • Bloody diarrhea
  • Lower abdominal cramps & fecal urgency
  • Anemia, low serum albumin
  • Negative stool cultures
  • Sigmoidoscopy is the key to diagnosis
slide5

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

slide6

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
slide7

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
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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
slide9

Distal colitis:

  • Early/ frequent relapse:
  • Maintenance- mesalamine supposositories (500mg/d)
  • -Oral 5-ASA agents
slide10

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
slide11

Severe colitis:

  • General:
  • Discontinue oral intake for 24-48hrs.
  • Total parenteral nutrition
  • Correct acid-base deficits,anemia
  • Treat C difficle infection if present.
slide12

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
slide13

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.
slide14

Refractory disease:

  • Mercaptopurine
  • Azathioprine
  • Transdermal nicotine
  • Infliximab
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