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Ulcerative Colitis Overview and Treatment

IBD is a chronic inflammatory disease of the intestines that includes ulcerative colitis and Crohn's disease. The causes are unclear but involve genetic and environmental factors. Ulcerative colitis affects only the colon and rectum with continuous inflammation, while Crohn's disease can impact any part of the digestive tract and cause skip lesions, stenosis, and fistulas. Treatment involves medications to reduce inflammation like 5-aminosalicylates, corticosteroids, immunomodulators, biologics, and sometimes surgery. The goal of treatment is achieving deep remission through not just symptom control but also mucosal healing.

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56 views2 pages

Ulcerative Colitis Overview and Treatment

IBD is a chronic inflammatory disease of the intestines that includes ulcerative colitis and Crohn's disease. The causes are unclear but involve genetic and environmental factors. Ulcerative colitis affects only the colon and rectum with continuous inflammation, while Crohn's disease can impact any part of the digestive tract and cause skip lesions, stenosis, and fistulas. Treatment involves medications to reduce inflammation like 5-aminosalicylates, corticosteroids, immunomodulators, biologics, and sometimes surgery. The goal of treatment is achieving deep remission through not just symptom control but also mucosal healing.

Uploaded by

Yoo An
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

DISEASE: IBD

IBD definition
 Chronic & life-long inflammatory intestinal disease of unclear etiopathogenesis (develops in young age and persists
for lifetime, with no definitive cure)
o Suggested pathogenesis: Microbial flora + Immune dysregulation + Genetic susceptibility + Environmental
triggers
 Consists of
o Ulcerative Colitis (UC)
o Crohn’s Disease (CD)
o In some countries, also GI Behçet's disease (BD)
o IBD-unspecified (IBDU) = 5% of patients with IBD have both features of CD & UC

Diagnosis / Characteristics of IBD


UC CD

Characteristics Characteristics
 Middle & older age (20s-60s)  Younger age (10s-20s)
 Colon, Rectum  Whole GI tract
 ANCA+ (bloodwork)  ASCA+ (bloodwork)
 Continuous  Skip lesions
 Mucosal (shallow)  Stenosis, Fistula
 Transmural (deep)
Dx Dx
 Endoscopy / History / Histology (seen thru  Radiology (CT, MRI) / Surgery / Lab / Endoscopy /
microscope) History / Histology
S/Sx S/Sx
 Diarrhea (>4 weeks)  Diarrhea (>4 weeks)
 Rectal bleeding  Abd pain, Weight loss
 Mucus in stool  Obstruction, Constipation
 Perianal fistula
 Recurrence after surgery
Labs Labs
 ANCA+  Anemia
 CRP elevated
 Albumin decreased
 ASCA+

IBD Treatment
 Options:
o 5-ASA
o Antibiotics
o Steroids (Budesonide, Beclomethasone)
o Immunomodulators (Azathioprine/6-MP, Methotrexate)
o Small molecules (JAK inhibitor)
o Biologics (anti-TNF, Anti-integrin, Anti-IL12/IL23)
 Mild-Mod disease: Step-Up Approach / Accelerated Step-Up Approach
o Weakest --> Strongest
 5-ASA, Antibiotics --> Steroids --> Immunomodulators --> Biologics --> Surgery
o Pros:
 Avoids unnecessary immunosuppression & drug ADEs
 Reduces cost
o Cons:
 Can cause complications (stricture, penetration, bleeding, malignancy)
 Can cause drug intolerance
 Can cause refractory disease
 Severe disease: Top-Down Approach
o Early use of potent drugs
 Biologics, Immunomodulators --> Immunomodulators, Steroids, ASA --> Immunomodulators, Surgery,
Antibiotics, ASA
o Pros:
 Maximizes efficacy of therapy – Rapid remission
 Avoids long-term complications
 Modifies disease course
o Cons:
 Overtreatment
 Cost & reimbursement
 Long-term safety?
 Treat to target:
o Goal should NOT be symptom control, but deep remission & inflammation control
 Deep remission = symptom control + mucosal healing
 UC:
 Normal stool frequency
 Pain control
 Endoscopic/Radiologic mucosal healing
 (adjunctive target: biomarker remission)
 CD:
 No rectal bleeding
 Normal stool frequency
 Endoscopic mucosal healing
 (adjunctive target: histological remission, biomarker remission)
 Future option: Combination of biologics (TNF, integrin, interleukin)

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