Ulcerative colitis severe

Entamoeba histolytica is an anaerobic rhizopod that occurs in tropical and subtropical areas. It can cause intestinal and extraintestinal manifestations. It is transmitted orally by ingestion of cysts that develop into trophozoites in the large intestine. Amebic trophozoites release several cytolytic factors, e.g. amoe-bapore, which enable the parasite to invade tissue. In intestinal amoebiasis, E. histolyticatrophozoites invade the intestinal mucosa, causing a form of ulcerative colitis with bloody and mucous diarrhoea. Extraintestinal manifestation of amebiasis results in abscess formation, usually in the liver but sometimes in the brain. 

Create a patient-specific drug treatment plan based on symptoms, severity, and location of ulcerative colitis or Crohn s disease. 

Treatment of acute episodes of ulcerative colitis is dictated by the severity and extent of disease, and first-line therapy of mild to moderate disease involves oral or topical aminosalicylate derivatives. 

Ulcerative colitis Fever, tachycardia (with severe disease), dehydration, arthritis, hemorrhoids, anal fissures, perirectal abscesses... 

Treatment of acute episodes of ulcerative colitis is dictated by the severity and extent of disease, and first-line therapy of mild to moderate disease involves oral or topical aminosalicylate derivatives. Topical suppositories and enemas are preferred for active distal UC (left-sided disease and proctitis), as they deliver mesalamine directly to the site of inflammation. Topical mesalamine is superior to both topical corticosteroids and oral aminosalicylates for inducing remission in active mild to moderate UC.1,33,34 Enemas are appropriate for patients with... 

Gionchetti P, Rizzello F, Ferrieri A, Venturi A, Brignola C, Ferretti M, Peruzzo S, Miglioli M, Campieri M Rifaximin in patients with moderate or severe ulcerative colitis refractory to steroid-treatment A double-blind, placebo-controlled trial. Dig Dis Sci 1999 44 1220-1221. 

An increasing number of both clinical and laboratory-derived observations support the importance of luminal components in driving the inflammatory response in ulcerative colitis and Crohn s disease. Although its role is unclear, antibiotic therapy is commonly used in clinical practice for the treatment of moderately to severely active ulcerative colitis. Metronidazole and/or ciprofloxacin are currently employed in active Crohn s disease, particularly in patients with colonic involvement and with perianal disease. Rifaximin, a rifamycin-derived antibiotic, is characterized by a wide range of antibacterial activity and a very low systemic absorption. Some preliminary data show its efficacy in severe active ulcerative colitis, pouchitis and prevention of postoperative recurrence in Crohn s disease. 

Chapman RW, Selby WS, Jewell DP Controlled trial of intravenous metronidazole as adjunct to corticosteroids in severe ulcerative colitis. Gut 1986 27 1210-1212. 

Mantzaris GJ, Hatzis A, Kontogiannis P, Triadaphyllou G Intravenous tobramycin and metronidazole as an adjunct to corticosteroids in acute, severe ulcerative colitis. Am J Gastroenterol 1994 89 43-46. 

A major complication is toxic megacolon, a severe condition that occurs in up to 7.9% of ulcerative colitis patients admitted to hospitals. The patient with toxic megacolon usually has a high fever, tachycardia, distended abdomen, elevated white blood cell count, and a dilated colon. 

Corticosteroids and adrenocorticotropic hormone have been widely used for the treatment of ulcerative colitis and Crohn s disease and are used in moderate to severe disease. Prednisone is most commonly used. Budesonide is an oral controlled-release formulation that minimizes systemic effects. 

Immunosuppressive agents such as azathioprine and mercaptopurine (a metabohte of azathioprine) are sometimes used for the treatment of IBD. These agents are generally reserved for cases that are refractory to steroids and may be associated with serious adverse effects such as lymphomas, pancreatitis, or nephrotoxicity. Cyclosporine has been of short-term benefit in acute, severe ulcerative colitis when used in a continuous infusion. 

Steroids have a place in the treatment of moderate to severe ulcerative colitis that is unresponsive to maximal doses of oral and topical mesalamine. Prednisone up to 1 mg/kg/day or 40 to 60 mg daily may be used for patients who do not have an adequate response to sulfasalazine or mesalamine. 

Continuous IV infusion of cyclosporine (4 mg/kg/day) is recommended for patients with acute severe ulcerative colitis refractory to steroids. 

Additional BHT-derived 5-LO inhibitors bear heteroatom-linked 4-substituents. Searle s SC-45662 (50) was selective (25 1) for 5-LO over CO in cRBL (3.7 /iM) and in A23187-stimulated RBL-1 cells (7.1 yuM) [146]. Besides NSAID-like activity in RAA (down to 10 mg/kg p.o.), SC-45662 also inhibited GPB (ED30 16.7 mg/kg p.o.), and LTB4 release from ulcerative colitis rectal mucosal biopsy samples was decreased [147]. Several patents have described similar compounds where the alkyl substituent on sulphur is varied quite widely [148 151]. Oxidation of the distal sulphur was consistent with activity, while replacement of this sulphur with oxygen gave reduced potency. Simple alkyl groups, alkylene-linked esters and amides, and disulphide-linked alkanoic esters were also active in cRBL with similar potency free carboxylic acids were somewhat less potent. Oxidation of the sulphur attached to the phenolic ring destroyed the activity. 

Inflammatory Bowel Disease (IBD) comprises several diseases, including ulcerative colitis and Crohn s disease. Ulcerative cohtis is a disease of the colon, originating in the rectum and extending proximally to a variable extent. It frequently affects the entire colon but never... 

Decreased Gl motility Administer with caution to patients with Gl obstructive disorders use with caution in patients with conditions such as severe constipation, ulcerative colitis, and myasthenia gravis. 

Ulcerative colitis In the treatment of mild to moderate ulcerative colitis, and as adjunctive therapy in severe ulcerative colitis for the prolongation of the remission period between acute attacks of ulcerative colitis (refer to the sulfasalazine monograph in the Gl chapter). 

Gl Obstructive disease (eg, achalasia, pyloroduodenal stenosis or pyloric obstruction, cardiospasm) paralytic ileus intestinal atony of the elderly or debilitated severe ulcerative colitis toxic megacolon complicating ulcerative colitis hepatic disease. 

Treatments are broadly the same as for ulcerative colitis being based on appropriate supportive measures, and the use of corticosteroids, the cytokine infliximab or adalimumab for severe and complicated disease and immunosuppressants, typically azathio-prine, for reducing the chances of relapse. Full thickness disease leading to flstulation, free perforation, abscess formation and stricturing usually requires surgery. Aminosalicylates appear ineffective in reducing the chances of relapse. 

Contraindications Bladder neck obstruction due to prostatic hypertrophy, cardiospasm, intestinal atony, myasthenia gravis in those not treated with neostigmine, narrow-angle glaucoma, obstructive disease of the GI tract, paralytic ileus, severe ulcerative colitis, tachycardia secondary to cardiac insufficiency or thyrotoxicosis, toxic megacolon, unstable cardiovascular status in acute hemorrhage... 

Contraindications Glaucoma, obstructive uropathy, obstructive disease of Gl-anti-cholinergic tract, paralytic ileus, intestinal atony of the elderly or debilitated patient, unstable cardiovascular status in acute hemorrhage, severe ulcerative colitis especially if complicated by toxic megacolon, myasthenia gravis, hiatal hernia associated with reflux esophagitis, hypersensitivity to any component of f he formulaf ion, acuf e infermiffenf porphyria. 

Contraindications Angle-closure glaucoma, benign prostatichyperplasia, GI obstruction, intestinal atony, megacolon, myasthenia gravis, paralytic ileus, severe ulcerative colitis... 

Crohn s disease, moderate to severe, ulcerative colitis, psoriatic arthritis IV Infusion... 

Contraindications GI or genitourinary (GU) obstruction, myasthenia gravis, narrow-angle glaucoma, toxic megacolon, severe ulcerative colitis, unstable cardiovascular adjustment in acute hemorrhage, hypersensitivity to propantheline or other anticholinergics... 

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