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Induction of remission in ulcerative colitis

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Trends in Inflammatory Bowel Disease Therapy 1999

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Abstract

Therapy for acute ulcerative colitis begins with an assessment of disease extent, severity and the response to prior treatments.

Mild-moderate activity can be treated with oral mesalamine in the setting of extensive colitis, or topical mesalamine or topical corticosteroids for distal disease. The dose-response is relevant for oral mesalamine, but is less important for topical therapy (in which case the frequency of topical administration and retention time correlate with efficacy).

Moderate-severe extensive colitis requires corticosteroid therapy whereas distal disease can still be treated with topical mesalamine or topical corticosteroids.

Severe-fulminant colitis requires hospitalization and parenteral corticosteroids. While there is no extensive evidence base for dose or product selection, there is sufficient clinical experience to arrive at sequential recommendations and contingencies. Significant improvement is anticipated within 3-5 days of initiating steroids at doses comparable to 40–60 mg of prednisolone or 200–400 mg of hydrocortisone. Patients who do not respond within 7 days are unlikely to improve. Failure to improve on parenteral steroids is indication for either colectomy or treatment with cyclosporin. Cyclosporin has been repeatedly demonstrated to provide prompt improvement in approximately 70-80% of patients within 3–5 days. Failure to respond with a reduction in bowel movements, cessation of bleeding and transfusion requirements and reduction in C-reactive protein (or erythrocyte sedimentation rate) within a week implies treatment failure and is an indication for colectomy. Total parenteral nutrition is adjunctive rather than primary therapy for patients with severe colitis who should be allowed to eat as long as they have an appetite. Narcotic analgesia is contraindicated, as are non-steroidal anti-inflammatory agents. The roles of topical mesalamine, infliximab and heparin in the setting of fulminant disease or toxic megacolon have not been established.

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References

  1. Hanauer SB. Review Articles: Drug therapy: inflammatory bowel disease. N Engl J Med 1996;334:841–8.

    Article  PubMed  CAS  Google Scholar 

  2. Kornbluth A, Sachar DB. Ulcerative colitis practice guidelines in adults. American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol 1997;92:204–11.

    PubMed  CAS  Google Scholar 

  3. Truelove SC, Witts IJ. Cortisone in ulcerative colitis. Final report on a therapeutic trial. Br Med J 1995;2:1041–7.

    Article  Google Scholar 

  4. Fredd S. Standards for approval of new drugs for IBD. Inflam Bowel Dis 1995;1:284–94.

    Article  Google Scholar 

  5. Irvine EJ. Quality of life issues in patients with inflammatory bowel disease. Am J Gastroenterol 1997;92(12 Suppl.):18–245.

    Google Scholar 

  6. Irvine EJ. Measuring quality of life: a review. Scand J Gastroenterol Suppl 1996;221:5–7.

    Article  PubMed  CAS  Google Scholar 

  7. Koutroubakis I et al. Environmental risk factors in inflammatory bowel disease. Hepatogastroenterology 1996;43:381–93.

    PubMed  CAS  Google Scholar 

  8. Schumacher G, Sandsted B, Kollberg B. A prospective study of first attacks of inflammatory bowel disease and infectious colitis. Clinical findings and early diagnosis. Scand J Gastroenterol 1994;29:265–74.

    Article  PubMed  CAS  Google Scholar 

  9. Miner PB, Jr. Factors influencing the relapse of patients with inflammatory bowel disease. Am J Gastroenterol 1997;92(12 Suppl.):1–4S.

    Google Scholar 

  10. Hilsden RJ, Scott CM, Verhoef MJ. Complementary medicine use by patients with inflammatory bowel disease [see comments]. Am J Gastroenterol 1998;93:697–701.

    Article  PubMed  CAS  Google Scholar 

  11. Thomas GA, Rhodes J, Green JT. Inflammatory bowel disease and smoking-a review. Am J Gastroenterol 1998;93:144–9.

    PubMed  CAS  Google Scholar 

  12. Fraga XF et al. Effects of smoking on the presentation and clinical course of inflammatory bowel disease. Eur J Gastroenterol Hepatol 1997;9:683–7.

    Article  PubMed  CAS  Google Scholar 

  13. Cohen RD, Hanauer SB. Protection from primary sclerosing cholangitis: smoke trails of just coattails? [editorial; comment]. Gastroenterology 1996;110:1658–62.

    Article  PubMed  CAS  Google Scholar 

  14. Silvennoinen JA, Lehtola JK, Niemela SE. Smoking is a risk factor for osteoporosis in women with inflammatory bowel disease. Scand J Gastroenterol 1996;31:367–71.

    Article  PubMed  CAS  Google Scholar 

  15. Bjarnason I et al. Side effects of nonsteroidal anti-inflammatory drugs on the small and large intestine in humans [see comments]. Gastroenterology 1993;104:1832–47.

    PubMed  CAS  Google Scholar 

  16. Hamilton FA. Non-narcotic analgesics: renal and GI considerations. Clinician 1998;16:1–22.

    Google Scholar 

  17. Gionchetti P et al. Comparison of oral with rectal mesalamine in the treatment of ulcerative procitis. Dis Colon Rectum 1998;41:93–7.

    Article  PubMed  CAS  Google Scholar 

  18. Marshall JK, Irvine EJ. Rectal corticosteroids versus alternative treatments in ulcerative colitis: a meta-analysis. Gut 1997;40:775 81.

    Google Scholar 

  19. Campieri M et al. Optimum dosage of 5-aminosalicylic acid as rectal enemas in patients with active ulcerative colitis. Gut 1991;32:929–31.

    Article  PubMed  CAS  Google Scholar 

  20. Hanauer SB. Dose-ranging study of mesalamine (PENTASA) enemas in the treatment of acute ulcerative proctosigmoiditis: results of a multicentered placebo-controlled trial. The U.S. PENTASA Enema Study Group [In Process Citation]. Inflamm Bowel Dis 1998;4:79–83.

    PubMed  CAS  Google Scholar 

  21. Safdi M et al. A double-blind comparison of oral versus rectal mesalamine versus combination therapy in the treatment of distal ulcerative colitis. Am J Gastroenterol 1997;92:1867–71.

    PubMed  CAS  Google Scholar 

  22. Sutherland LR, Roth DE, Beck PL. Alternatives to sulfasalazine: a meta-analysis of 5-ASA in the treatment of ulcerative colitis. Inflam Bowel Dis 1997;3:65–78.

    Google Scholar 

  23. Mulder CJJ et al. A controlled randomized trial of beclomethasone dipropionate (3 mg) versus 5-aminosalicylic acid (I g) versus the combination of both as retention enemas in active distal ulcerative colitis. Gastroenterology, 1994:106:A739.

    Google Scholar 

  24. Langholz E et al. Changes in extent of ulcerative colitis: a study on the course and prognostic factors. Scand J Gastroenterol 1996;31:260–6.

    Article  PubMed  CAS  Google Scholar 

  25. Sutherland L et al. Systematic review of the use of oral 5-aminosalicylic acid in the induction of remission in ulcerative colitis (Cochrane Review). The Cochrane Library. Vol. Issue 3 Oxford: Update Software; 1998.

    Google Scholar 

  26. Kornbluth AA et al. Meta-analysis of the effectiveness of current drug therapy of ulcerative colitis. J Clin Gastroenterol 1993;16:215–18.

    Article  PubMed  CAS  Google Scholar 

  27. George J et al. The long-term outcome of ulcerative colitis treated with 6-mercaptopurine. Am J Gastroenterol 1996:91:1711–14.

    PubMed  CAS  Google Scholar 

  28. Sandborn WJ. Azathioprine: state of the art in inflammatory bowel disease. Scand J Gastroenterol Suppl 1998;225:92 9.

    Google Scholar 

  29. Andreassen H et al. Inflammatory bowel disease and osteoporosis. Scand J Gastroenterol 1997;32:1247–55.

    Article  PubMed  CAS  Google Scholar 

  30. Compston JE. Review article: osteoporosis, corticosteroids and inflammatory bowel disease. Aliment Pharmacol Ther 1995;9:237–50.

    Article  PubMed  CAS  Google Scholar 

  31. Ziegler R, Kasperk C. Glucocorticoid-induced osteoporosis: prevention and treatment. Steroids 1998;63:344–8.

    Article  PubMed  CAS  Google Scholar 

  32. Truelove SC et al. Further experience in the treatment of severe attacks of ulcerative colitis. Lancet 1978;2:1086–8.

    Article  PubMed  CAS  Google Scholar 

  33. Jarnerot G, Rolny P, Sandberg-Gertzen H. Intensive intravenous treatment of ulcerative colitis. Gastroenterology 1985;89:1005–13.

    PubMed  CAS  Google Scholar 

  34. Kornbluth A et al. How effective is current medical therapy for severe ulcerative and Crohn’s colitis? An analytic review of selected trials. J Clin Gastroenterol 1995;20:280–4.

    Article  PubMed  CAS  Google Scholar 

  35. Stein R, Hanauer SB. Life-threatening complications of IBD: how to handle fulminant colitis and toxic megacolon. J Crit Illness 1998;13:518–25.

    Google Scholar 

  36. Rosenberg W, Ireland A, Jewell DP High-dose methylprednisolone in the treatment of active ulcerative colitis. J Clin Gastroenterol 1990;12:40–1.

    Article  PubMed  CAS  Google Scholar 

  37. Meyers S et al. Corticotropin versus hydrocortisone in the intravenous treatment of ulcerative colitis. A prospective, randomized, double-blind clinical trial. Gastroenterology 1983;85:351–7.

    PubMed  CAS  Google Scholar 

  38. Marion JF, Present DH. The modern medical management of acute, severe ulcerative colitis. Eur J Gastroenterol Hepatol 1997;9:831–5.

    Article  PubMed  CAS  Google Scholar 

  39. Chakraborty TK et al. Salicylate induced exacerbation of ulcerative colitis. Gut 1987;28:613–15.

    Article  PubMed  CAS  Google Scholar 

  40. Hanauer SB, Stathopoulos G. Risk -benefit assessment of drugs used in the treatment of inflammatory bowel disease. Drug Saf 1991;6:192–219.

    Article  PubMed  CAS  Google Scholar 

  41. Travis SP et al. Predicting outcome in severe ulcerative colitis. Gut 1996;38:905–10.

    Article  PubMed  CAS  Google Scholar 

  42. Chakravarty BJ. Predictors and the rate of medical treatment failure in ulcerative colitis. Am J Gastroenterol 1993;88:852–5.

    PubMed  CAS  Google Scholar 

  43. Langford CA et al. Use of cytotoxic agents and cyclosporine in the treatment of autoimmune disease. Part 2: Inflammatory bowel disease, systemic vascultis, and therapeutic toxicity. Ann Intern Med 1998;129:49–58.

    PubMed  CAS  Google Scholar 

  44. Atkinson KA et al. Intravenous cyclosporine for severe attacks of ulcerative colitis: a survey of Canadian gastroenterologists. Can J Gastroenterol 1997;11:583–7.

    CAS  Google Scholar 

  45. Sandborn W. A critical review of cyclosporine therapy in inflammatory bowel disease. Inflam Bowel Dis 1995;1:48–63.

    Google Scholar 

  46. Lichtiger S et al. Cyclosporine in severe ulcerative colitis refractory to steroid therapy [see comments]. N Engl J Med 1994;330:1841–5.

    Article  PubMed  CAS  Google Scholar 

  47. Van Gossum A et al. Short-and long-term efficacy of cyclosporin administration in patients with acute severe ulcerative colitis. Belgian IBD Group. Acta Gastroenterol Belg 1997;60:197–200.

    PubMed  Google Scholar 

  48. Wenzl HH et al. Short-term efficacy and long-term outcome of cyclosporine treatment in patients with severe ulcerative colitis. Z Gastroenterol 1998;36:287–93.

    PubMed  CAS  Google Scholar 

  49. Actis GC et al. Continuously infused cyclosporine at low dose is sufficient to avoid emergency colectomy in acute attacks of ulcerative colitis without the need for high-dose steroids. J Clin Gastroenterol 1993;17:10–13.

    Article  PubMed  CAS  Google Scholar 

  50. Kornbluth A et al. Cyclosporin for severe ulcerative colitis: a user’s guide. Am J Gastroenterol 1997;92:1424–8.

    PubMed  CAS  Google Scholar 

  51. Cohen RD, Stein R, Hanauer SB. Intravenous cyclosporin in ulcerative colitis: a five-year experience. Am J Gastroenterol 1999;94:1587–92.

    Article  PubMed  CAS  Google Scholar 

  52. Fernandez-Banares F et al. Azathioprine is useful in maintaining long-term remission induced by intravenous cyclosporine in steroid-refractory severe ulcerative colitis. Am J Gastroenterol 1996;91:2498–9.

    PubMed  CAS  Google Scholar 

  53. Ramakrishna J et al. Combined use of cyclosporine and azathioprine or 6-mercaptopurine in pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr 1996;22:296–302.

    Article  PubMed  CAS  Google Scholar 

  54. Panos MZ, Wood MJ, Asquith P. Toxic megacolon: the knee-elbow position relieves bowel distension [see comments]. Gut 1993;34:1726–7.

    Article  PubMed  CAS  Google Scholar 

  55. Seelig MH et al. Surgical therapy of severe colitis. Chirurg 1996;67:150–4.

    PubMed  CAS  Google Scholar 

  56. Kornbluth A et al. How effective is current medical therapy for severe ulcerative and Crohn’s colitis? An analytic review of selected trials. J Clin Gastroenterol 1995;20:280–4.

    Article  PubMed  CAS  Google Scholar 

  57. Sheth SG, LaMont JT. Toxic megacolon. Lancet 1998;351:509–13.

    Article  PubMed  CAS  Google Scholar 

  58. Griffin MG, Miner PB. Review article: Refractory distal colitis - explanations and options. Aliment Pharmacol Ther 1996;10:39–48.

    Article  PubMed  CAS  Google Scholar 

  59. Biddle WL, Miner PB. Jr. Long-term use of mesalamine enemas to induce remission in ulcerative colitis. Gastroenterology 1990;99:113–18.

    PubMed  CAS  Google Scholar 

  60. Hanauer SB. No butts about it: put the fire out by lighting up [comment]. Inflamm Bowel Dis 1998;4:326 (discussion 327).

    Google Scholar 

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Authors
  1. S. B. Hanauer
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Editors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada

    C. N. Williams

  2. Faculty of Medicine, The Health Sciences Centre, Memorial University of Newfoundland, St John’s, Newfoundland, Canada

    R. F. Bursey

  3. Faculty of Medicine, The University of Calgary, Alberta, Canada

    D. G. Gall , L. R. Sutherland  & J. L. Wallace ,  & 

  4. University of Montreal, Canada

    F. Martin

  5. Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada

    R. S. McLeod

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© 2000 Springer Science+Business Media Dordrecht

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Hanauer, S.B. (2000). Induction of remission in ulcerative colitis. In: Williams, C.N., et al. Trends in Inflammatory Bowel Disease Therapy 1999. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-4002-7_11

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  • DOI: https://doi.org/10.1007/978-94-011-4002-7_11

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-5769-1

  • Online ISBN: 978-94-011-4002-7

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