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Medical Treatment of Ulcerative Colitis

  • Fosca De Iorio
  • Luigi Benini
  • Naika Tacchella
  • Italo Vantini

Conclusions

Many different and evolving approaches are available for the treatment of ulcerative colitis. A comprehensive treatment that includes not just the disease but also the patient (often severely debilitated by a lifelong disease, in a proportion of cases refractory to standard treatments) and an effective patient-doctor alliance may improve the overall results.

Keywords

Inflammatory Bowel Disease Ulcerative Colitis Ulcerative Colitis Patient Active Ulcerative Colitis Severe Ulcerative Colitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Loftus EV Jr (2004) Clinical epidemiology of inflammatory bowel disease: incidence, prevalence and environmental influences. Gastroenterology 126:1504–1517PubMedCrossRefGoogle Scholar
  2. 2.
    Longobardi T, Jacobs T, Wu L et al (2003) Work losses related to inflammatory bowel disease in Canada: results from a national population health survey. Am J Gastroenterology 98:844–849CrossRefGoogle Scholar
  3. 3.
    Card T, Hubbard R, Logan RFA (2003) Mortality in inflammatory bowel disease: a population-based cohort study. Gastroenterology 125:1583–1590PubMedCrossRefGoogle Scholar
  4. 4.
    Carter MJ, Lobo AJ Travis SPL (2004) Guidelines for the management of inflammatory bowel disease in adults. Gut 53:v1–v16PubMedCrossRefGoogle Scholar
  5. 5.
    Sutherland LR, May GR, Shaffer EA (1993) Sulfasalazine revisited: a meta-analysis of 5-aminosalicylic acid in the treatment of ulcerative colitis. Ann Intern Med 118:540–549PubMedGoogle Scholar
  6. 6.
    Sutherland L, Roth D, Beck P et al (2000) Oral 5-aminosalicylic acid for inducing remission in ulcerative colitis. Cochrane Database Syst Rev 2:CD000543Google Scholar
  7. 7.
    Hanauer S, Schwartz J, Robinson M et al (1993) Mesalamine capsules for treatment of active ulcerative colitis: results of a controlled trial: Pentasa Study Group. Am J Gastroenterol 88:1188–1197PubMedGoogle Scholar
  8. 8.
    Green JR, Lobo AJ, Holdsworth CD et al (1998) Balsalazide is more effective and better tolerated than mesalamine in the treatment of acute ulcerative colitis: The Abacus Investigator Group. Gastroenterology 114:15–22PubMedCrossRefGoogle Scholar
  9. 9.
    Kruis W, Brandes JW, Schreiber S et al (1998) Olsalazine versus mesalazine in the treatment of mild to moderate ulcerative colitis. Aliment Pharmacol Ther 12:707–715PubMedCrossRefGoogle Scholar
  10. 10.
    Miner P, Hanauer S, Robinson M et al (1995) Safety and efficacy of controlled-release mesalamine for maintenance of remission in ulcerative colitis: Pentasa UC Maintenance Study Group. Dig Dis Sci 40:296–304PubMedCrossRefGoogle Scholar
  11. 11.
    Hawkey CJ, Dube LM, Rountree LV et al (1997) A trial of zileuton versus mesalazine or placebo in the maintenance of remission of ulcerative colitis: The European Zileuton Study Group For Ulcerative Colitis. Gastroenterology 112:718–724PubMedCrossRefGoogle Scholar
  12. 12.
    Sandberg-Gertzen H, Jarnerot G, Kraaz W (1986) Azodisal sodium in the treatment of ulcerative colitis: a study of tolerance and relapse-prevention properties. Gastroenterology 90:1024–1030PubMedGoogle Scholar
  13. 13.
    Wright JP, O’Keefe EA, Cuming L, Jaskiewicz K (1993) Olsalazine in maintenance of clinical remission in patients with ulcerative colitis. Dig Dis Sci 38:1837–1842PubMedCrossRefGoogle Scholar
  14. 14.
    Hanauer S, Sninsky C, Robinson M et al (1996) An oral preparation of mesalamine as longterm maintenance therapy for ulcerative colitis: a randomized, placebocontrolled trial. Ann Intern Med 124:204–211Google Scholar
  15. 15.
    Ardizzone S, Petrillo M, Imbesi V et al (1999) Is maintenance therapy always necessary for patients with ulcerative colitis in remission? Aliment Pharmacol Ther 13:373–379PubMedCrossRefGoogle Scholar
  16. 16.
    Miner P, Hanauer S, Robinson M et al (1995) Safety and efficacy of controlled-release mesalamine for maintenance of remission in ulcerative colitis: Pentasa UC Maintenance Study Group. Dig Dis Sci 40:296–304PubMedCrossRefGoogle Scholar
  17. 17.
    Ngo Y, Gelinet JM, Ivanovic A et al (1992) Efficacy of a daily application of mesalazine (Pentasa) suppository with progressive release, in the treatment of ulcerative proctitis: a double-blind versus placebo randomized trial [In French]. Gastroenterol Clin Biol 16:782–786PubMedGoogle Scholar
  18. 18.
    Williams CN, Haber G, Aquino JA (1987) Doubleblind, placebo-controlled evaluation of 5-ASA suppositories in active distal proctitis and measurement of extent of spread using 99mTc labeled 5-ASA suppositories. Dig Dis Sci 32:71S–75SPubMedCrossRefGoogle Scholar
  19. 19.
    Campieri M, De Franchis R, Bianchi Porro G et al (1990) Mesalazine (5-aminosalicylic acid) suppositories in the treatment of ulcerative proctitis or distal proctosigmoiditis: a randomized controlled trial. Scand J Gastroenterol 25:663–668PubMedGoogle Scholar
  20. 20.
    Campieri M, Gionchetti P, Belluzzi A et al (1990) Topical treatment with 5-aminosalicylic in distal ulcerative colitis by using a new suppository preparation: a double-blind placebo controlled trial. Int J Colorectal Dis 5:79–81PubMedCrossRefGoogle Scholar
  21. 21.
    Campieri M, Gionchetti P, Belluzzi A et al (1991) Optimum dosage of 5-aminosalicylic acid as rectal enemas in patients with active ulcerative colitis. Gut 32:929–931PubMedGoogle Scholar
  22. 22.
    Sutherland LR, Martin F, Greer S et al (1987) 5-Aminosalicylic acid enema in the treatment of distal ulcerative colitis, proctosigmoiditis, and proctitis. Gastroenterology 92:1894–1898PubMedGoogle Scholar
  23. 23.
    Campieri M, Gionchetti P, Belluzzi A (1990) Sucralfate, 5-aminosalicylic acid, and placebo enemas in the treatment of distal ulcerative colitis. Eur J Gastroenterol Hepatol 3:41–44Google Scholar
  24. 24.
    Hanauer SB (1998) Dose-ranging study of mesalamine (PENTASA) enemas in the treatment of acute ulcerative proctosigmoiditis: results of a multicentered placebo-controlled trial: The US Pentasa Enema Study Group. Inflamm Bowel Dis 4:79–83PubMedCrossRefGoogle Scholar
  25. 25.
    Marshall JK, Irvine EJ (1995) Rectal aminosalicylate therapy for distal ulcerative colitis: a meta-analysis. Aliment Pharmacol Ther 9:293–300PubMedCrossRefGoogle Scholar
  26. 26.
    Cohen RD, Woseth DM, Thisted RA, Hanauer SB (2000) A meta-analysis and overview of the literature on treatment options for left-sided ulcerative colitis and ulcerative proctitis. Am J Gastroenterology 95:1263–1276CrossRefGoogle Scholar
  27. 27.
    Kam L, Cohen H, Dooley C et al (1996) A comparison of mesalamine suspension enema and oral sulfasalazine for treatment of active distal ulcerative colitis in adults. Am J Gastroenterol 91:1338–1342PubMedGoogle Scholar
  28. 28.
    Reddy SI, Friedmanm S, Telford JJ et al (2005) Are patients with inflammatory bowel disease receiving optimal care? Am J Gastroenterol 100:1357–1361PubMedCrossRefGoogle Scholar
  29. 29.
    Sachar DB (2003) Ten common errors in the management of inflammatory bowel disease. Inflamm Bowel Dis 9:205–209PubMedCrossRefGoogle Scholar
  30. 30.
    Loftus EV, Kane SV, Bjorkman D (2004) Systemic review: short-term adverse effects of 5-aminosalicylic acid agents in the treatment of ulcerative colitis. Aliment Pharmacol Ther 19:179–189PubMedCrossRefGoogle Scholar
  31. 31.
    Ransford RAJ, Langman MJS (2002) Sulphasalazine and mesalazine: serious adverse reactions re-evaluated on the basis of suspected adverse reaction reports to the Committee on Safety of Medicines. Gut 51:536–539PubMedCrossRefGoogle Scholar
  32. 32.
    Van Staa TP, Travis SPL, Leufkens HJM et al (2004) 5-aminosalicylic acids and the risk of renal disease: a large British epidemiological study. Gastroenterology 126:1733–1739PubMedCrossRefGoogle Scholar
  33. 33.
    Rosenberg JL, Wall AJ, Levin B et al (1975) A controlled trial of azathioprine in the management of chronic ulcerative colitis. Gastroenterology 69:96–99PubMedGoogle Scholar
  34. 34.
    Kirk AP, Lennard-Jones JE (1982) Controlled trial of azathioprine in chronic ulcerative colitis. Br Med J (Clin Res Ed) 284:1291–1292Google Scholar
  35. 35.
    Fraser AG, Orchard TR, Jewell DP (2002) The efficacy of azathioprine for the treatment of inflammatory bowel disease: a 30 year review. Gut 50:485–489PubMedCrossRefGoogle Scholar
  36. 36.
    Ardizzone S, Maconi G, Russo A et al (2006) Randomised controlled trial of azathioprine and 5-aminosalicylic acid for treatment of steroid dependent ulcerative colitis. Gut 55:47–53PubMedCrossRefGoogle Scholar
  37. 37.
    Mantzaris GJ, Archavlis E, Kourtessas D et al (2001) Oral azathioprine for steroid refractory severe ulcerative colitis. Am J Gastroenterol 96:2797–2808PubMedCrossRefGoogle Scholar
  38. 38.
    Ardizzone S, Molteni F, Imbesi V et al (1997) Azathioprine in steroid resistant and steroid dependant ulcerative colitis. J Clin Gastroenterol 25:330–333PubMedCrossRefGoogle Scholar
  39. 39.
    Lennard L, Gibson BE, Nicole T (1993) Congenital thiopurine methyltransferase deficiency and 6-mercaptopurine toxicity during treatment for acute lymphoblastic leukaemia. Arch Dis Child 69:577–579PubMedGoogle Scholar
  40. 40.
    Colombel JF, Ferrari N, Debuysere H et al (2000) Genotypic analysis of thiopurine S-methyltransferase in patients with Crohn’s disease and severe myelosuppression during azathioprine therapy. Gastroenterology 118:1025–1030PubMedCrossRefGoogle Scholar
  41. 41.
    Sandborn WJ, Tremaine WJ, Wolf DC et al (1999) Lack of effect of intravenous administration on time to respond to azathioprine for steroid-treated Crohn’s disease. Gastroenterology 117:527–535PubMedCrossRefGoogle Scholar
  42. 42.
    The mycophenolate mofetil refractory rejection study group (1996) Mycophenolate mofetil for the treatment of refractory acute, cellular renal transplantation rejection. Transplantation 61:722–729CrossRefGoogle Scholar
  43. 43.
    Farell RJ, Ang Y, Kileen P et al (2000) Increased incidence of non Hodgkin’s lymphoma in inflammatory bowel disease patients on immunosuppressive therapy but overall risk is low. Gut 47:514–519CrossRefGoogle Scholar
  44. 44.
    Connel WR, Kamm MA, Dickson MB et al (1994) Long-term neoplasia risk after azathioprine treatment in inflammatory bowel disease. Lancet 343:1249–1252CrossRefGoogle Scholar
  45. 45.
    — (2005) Increased risk of lymphoma among inflammatory bowel disease patients treated with azathioprine and 6-mercaptopurine Gut 54:1121–1125CrossRefGoogle Scholar
  46. 46.
    Fraser Ag, Jewell DP (2000) Long-term risk of malignancy after treatment of inflammatory bowel disease with azathioprine: a 30 years study. Gastroenterology 118:A1471Google Scholar
  47. 47.
    Lewis JD, Bilker WB, Brensinger C et al (2001) Inflammatory bowel disease is not associated with an increased risk of lymphoma. Gastroenterology 121:1080–1087PubMedCrossRefGoogle Scholar
  48. 48.
    Francella A, Dyan A, Bodian C et al (2003) The safety of 6 mercaptopurine for childbearing patients with inflammatory bowel disease: a retrospective cohort study. Gastroenterology 124:9–17PubMedCrossRefGoogle Scholar
  49. 49.
    Stange EF, Neurath MF (1996) Methotrexate in chronic active ulcerative colitis: a double-blind, randomized, Israeli multicenter trial. Gastroenterology 110:1416–1421CrossRefGoogle Scholar
  50. 50.
    Mate-Jimenez J, Hermida C, Cantero-Perona J, Moreno Otero R (2000) 6-mercaptopurine or methotrexate added to prednisone induces and maintains remission in steroid-dependent inflammatory bowel disease. Eur J Gastroenterol Hepatol 12:1227–1233PubMedCrossRefGoogle Scholar
  51. 51.
    Morton D, McGovern D, Jewell DP (2002) The efficacy of methotrexate for maintaining remission in inflammatory bowel disease Aliment Pharmacol Ther 16:693–697PubMedCrossRefGoogle Scholar
  52. 52.
    Te HS, Schiano TD, Kuan SF et al (2000) Hepatic effects of long-term methotrexate use in the treatment of inflammatory bowel disease. Am J Gastroenterol 95:3150–3156PubMedCrossRefGoogle Scholar
  53. 53.
    Lichtiger S, Present DH, Kornbluth A et al (1994) Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J of Med 330:1841–1845CrossRefGoogle Scholar
  54. 54.
    D’Heans G, Lemmens L, Geboes K et al (2001) Intravenous cyclosporine versus intravenous corticosteroids as single therapy for severe attacks of ulcerative colitis. Gastroenterology 120:1323–1329CrossRefGoogle Scholar
  55. 55.
    Svanoni F, Bonassi U, Bagnolo F et al (1998) Effectiveness of cyclosporine A (CsA) in the treatment of active refractory ulcerative colitis (UC). Gastroenterology 114:A1096CrossRefGoogle Scholar
  56. 56.
    Van Assche G, D’Haens G, Noman M et al (2003) Randomized, double-blind comparison of 4 mg/kg versus 2 mg/kg intravenous cyclosporine in severe ulcerative colitis. Gastroenterology 125:1025–1031PubMedCrossRefGoogle Scholar
  57. 57.
    Sandborn WJ, Tremaine WJ, Schroeder KW et al (1994) A placebo-controlled trial of cyclosporine enemas for mildly-moderate active left-sided ulcerative colitis. Gastroenterology 106:1429–1435PubMedGoogle Scholar
  58. 58.
    Travis SP, Farrant JM, Ricketts C et al (1996) Predicting outcome in ulcerative colitis. Gut 38:905–910PubMedGoogle Scholar
  59. 59.
    Lindgren SC, Flood LM, Kilander AF et al (1998) Early predictors of glucocorticoids treatment failure in severe and moderately severe attacks of ulcerative colitis. Eur J Gastroenterol Hepatol 10:831–835PubMedCrossRefGoogle Scholar
  60. 60.
    Schibolet O, Regushevskaya E, Brezis M, Soares-Weise K (2005) Cyclosporin A for induction of remission in severe ulcerative colitis. The Cochrane Database of Systematic Review Issue 4Google Scholar
  61. 61.
    Sternthal M, George J, Kornbluth A et al (1996) Toxicity associated with the use of cyclosporine in patients with inflammatory bowel disease. Gastroenterology 110:A1019Google Scholar
  62. 62.
    De Groen PC, Aksamit AJ, Rakela J et al (1987) Central nervous system toxicity after liver transplantation: the role of cyclosporine and cholesterol. N Engl J Med 317:861–866PubMedCrossRefGoogle Scholar
  63. 63.
    Fellermann K, Ludwig D, Stahl M et al (1998) Steroidunresponsive acute attacks of inflammatory bowel disease: immunomodulation by tacrolimus (FK506). Am J Gastroenterol 93:1860–1866PubMedCrossRefGoogle Scholar
  64. 64.
    Baumgart DC, Wiedenmann B, Dignass AU (2003) Rescue therapy with tacrolimus is effective in patients with severe and refractory inflammatory bowel disease. Aliment Pharmacol Ther 15:1273–1281CrossRefGoogle Scholar
  65. 65.
    Hogenauer C, Wenzl HH, Hinterleitner TA, Petritsch W (2003) Effect of oral tacrolimus on steroid-refractory moderate/severe ulcerative colitis. Aliment Pharmacol Ther 18:415–423PubMedCrossRefGoogle Scholar
  66. 66.
    Actis GC, Bruno M, Pinna-Pintor M, Rossini FP, Rizzetto M (2002) Infliximab for treatment of steroidrefractory ulcerative colitis. Dig Liver Dis 34:631–634PubMedCrossRefGoogle Scholar
  67. 67.
    Gornet Jm, Couve S, Hassani Z et al (2003) Infliximab for refractory ulcerative colitis or indeterminate colitis: an open-label multicentre study. Aliment Pharmacol Ther 18:175–181PubMedCrossRefGoogle Scholar
  68. 68.
    Jarnerot G, Hertevig E, Friis-Liby I et al (2005) Infliximab as a rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo-controlled study. Gastroenterology 128:1805–1811PubMedCrossRefGoogle Scholar
  69. 69.
    Rutgeerts P, Sandborn WJ, Feagan BG et al (2005) Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med 353:2462–2476PubMedCrossRefGoogle Scholar
  70. 70.
    Musch E, Andus T, Malek M (2002) Induction and maintenance of clinical remission by interferon-beta in patients with steroid-refractory active ulcerative colitis: an open long-term pilot trial. Aliment Pharmacol Ther 16:1233–1239PubMedCrossRefGoogle Scholar
  71. 71.
    Nikolaus S, Rutgeerts P, Fedorak R (2003) Interferon b-1a in ulcerative colitis: a placebo-controlled, randomised, dose escalating study. Gut 52:1286–1290PubMedCrossRefGoogle Scholar
  72. 72.
    Musch E, Andus T, Kruis W et al (2005) Interferon beta-1a for the treatment of steroid refractory ulcerative-colitis: a randomized double-blind placebo-controlled trial. Clin Gastroenterol Hepatol 3:581–586PubMedCrossRefGoogle Scholar
  73. 73.
    Feagan BG, Greenberg GR, Wild G et al (2005) Treatment of ulcerative colitis with a humanized antibody to the a4b7 integrin. N Engl J Med 352:2499–2507PubMedCrossRefGoogle Scholar
  74. 74.
    Danese S, De La Rue SA, Gasbarrini A (2005) Antibody to the α4β7 integrin. N Engl J Med 353:118CrossRefGoogle Scholar
  75. 75.
    Kondo K, Shinoda T, Yoshimoto H (2001) Effective maintenance leukocytapheresis for patients with steroid dependent or resistant ulcerative colitis. Ther Apher 5:462–465PubMedCrossRefGoogle Scholar
  76. 76.
    Sakata H, Kawamura N, Takashi H et al (2003) Successful treatment of ulcerative colitis with leukocytapheresis using non-woven polyester filter. Ther Apher Dial 7:536–539PubMedCrossRefGoogle Scholar
  77. 77.
    Kanke K, Nakano M, Hiraishi H, Terano A (2004) Clinical evaluation of granulocyte/monocyte apheresis therapy for active ulcerative colitis. Dig Liver Dis 36:811–817PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2006

Authors and Affiliations

  • Fosca De Iorio
    • 1
  • Luigi Benini
    • 1
  • Naika Tacchella
    • 1
  • Italo Vantini
    • 1
  1. 1.Department of Biomedical and Surgical Sciences, Division of GastroenterologyPoliclinico “G.B. Rossi”VeronaItaly

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