Ulcerative colitis, treatment

Active ulcerative colitis Treatment of mildly to moderately active ulcerative colitis. 

Ulcerative colitis, treatment-refractory 5 mg/kg i.v. over 2h. at week 0, 2, and 6 and then every 8 weeks... 

Increased concentrations of eicosanoids (leukotriene B4, prostaglandin E2 [PGE2] and thromboxane A2) have been reported to exist in the colon mucosa and rectal areas of patients with ulcerative colitis (14). In 1993, a randomized, placebo-controlled study was conducted by Greenfield et al. examining the effect of OEP and fish oil supplementation on cell membranes and symptom control in 43 patients diagnosed with stable ulcerative colitis. Treatment with OEP increased red-cell membrane concentrations of dihomo-y-linolenic acid by 40% at 6 months (p < 0.05), and compared to MaxEPA and placebo, OEP significantly improved stool consistency at 6 months, with... 

Crohn s disease, rheumatoid arthritis Treatment of active to moderate ulcerative colitis, proctosigmoiditis, or proctitis... 

Bismudi subsalicylate is used in combination witii otiier dru > to treat gastric and duodenal ulcers caused by H. pylori bacteria Mesalamine is used in the treatment of chronic inflammatoiy bowel disease Misoprostol is used to prevent gastric ulcers in those taking aspirin or nonsteroidal anti-inflammatory dragp in high doses for a prolonged time Olsalazine is used in the treatment of ulcerative colitis in those allergic to sulfasalazine. Sulfasalazine is used in the treatment of Crohn s disease and ulcerative colitis. Sucralfate is used in the treatment of duodenal ulcer. 

Use treatment of gastrointestinal disorders (ulcerative colitis, Crohn s disease)... 

Describe pharmacologic treatment options for patients with acute or chronic symptoms of ulcerative colitis and Crohn s disease. 

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. 

Surgical intervention is a potential treatment option in patients with complications such as fistulae or abscesses, or in patients with medically refractory disease. Ulcerative colitis is curable with performance of a total colectomy. Patients with UC may opt to have a colectomy to reduce the chance of developing colorectal cancer. Patients with CD may have affected areas of intestine resected. Unfortunately, CD may recur following surgical resection. Repeated surgeries may lead to significant malabsorption of nutrients and drugs consistent with development of short-bowel syndrome. 

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... 

Roediger WEW, Moore J, Babidge W. 1997. Colonic sulfide in pathogenesis and treatment of ulcerative colitis. Dig Dis Sci 42 1571-1579. 

OAT Olsson, LA Svensson. Treatment of chronic ulcerative-colitis with poly-ASA—A new nonabsorbable carrier for release of 5-aminosalicylate in the colon. Pharm Res 19-23, 1984. 

While the role of PHD inhibitors in the treatment of anemia is now validated, therapeutic validation is less certain in other HIF-associated pathologies such as wound healing, ulcerative colitis, therapeutic angiogenesis, and treatment of acute ischemic events such as myocardial ischemia and stroke. All of these indications are supported by a compelling array of in vitro and in vivo preclinical studies but their utility in the clinical setting remains to be evaluated and represents exciting possibilities for the future of small-molecule inhibitors of PHD enzymes. 

Investigations performed in rats with experimental acute pancreatitis [196] or ulcerative colitis [197] have shown that both rectal and oral administration of rifaximin decreased colonic bacterial translocation towards mesenteric lymph nodes. In the model of ANP [196] not only was the intra-abdominal spread of enteric bacteria (fig. 8) significantly reduced but also the pancreatic damage was lessened by rifaximin treatment. 

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. 

Minimal effects on intestinal flora were seen with rifaximin administration [9, 35]. In an early study, performed on healthy volunteers who received a short-term (5 days) rifaximin treatment, the observed changes in bowel flora returned to baseline levels within 1-2 weeks [9]. In a recent investigation fecal samples of patients with ulcerative colitis given three 10 day courses of the antibiotic were cultured and the different microbial species quantitated. Despite the high dose (i.e. 1800 mg daily) of rifaximin used there was only a minor change in bacterial counts which reverted back to pre-treatment values during the washout period [35]. It appears therefore that administration of this antibiotic does not disrupt intestinal microbial ecology. 

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. 

Burke DA, Axon ATR, Clayden SA, Dixon MF, Johnston D, Lacey RW The efficacy of tobramycin in the treatment of ulcerative colitis. Aliment Pharmacol Ther 1990 4 123-129. 

Turunen UM, Farkkila MA, Hakala K, Seppala K, Sivonen A, Ogren M, Vuoristo M, Valtonen VV, Miettinen TA Long-term treatment of ulcerative colitis with ciprofloxacin A prospective, double-blind, placebo-controlled study. Gastroenterology 1998 115 1072-1078. 

The answers are 484-k 485-j. (tlardman, pp 1061-1062, 1682-1685.) Sulfonamides can cause acute hemolytic anemia. In some patients it mayr be related to a sensitization phenomenon, and in other patients the hemolysis is due to a glucose-6-phosphate dehydrogenase deficiency Sulfamethoxazole alone or in combination with trimethoprim is used to treat UTls. The sulfonamide sulfasalazine is employed in the treatment of ulcerative colitis. Daps one, a drug that is used in the treatment of leprosy, and primaquine, an anti mala rial agent, can produce hemolysis, particularly in patients with a glucose-6-phosphate dehydrogenase deficiency. 

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. 

Oral mesalamine derivatives (such as those listed in Table 26-5) are reasonable alternatives to sulfasalazine for treatment of ulcerative colitis but they are not more effective than sulfasalazine. 

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. 

Other studies describe similar beneficial effects for PUFA-enriched diets to treat Crohn s disease, other inflammatory bowel diseases such as ulcerative colitis, as well as psoriasis, asthma, systemic lupus erythematosus, and multiple sclerosis [57], Thus, immunomodulation by PUFAs appears to be a promising intervention for the treatment of many autoimmune and inflammatory diseases. 

A four-electron reduction of the azo group leads to the cleavage of the molecule and the production of two amines (Fig. 5.10). There are few drugs that contain an azo bond but a good example is sulfasalazine, which is reductively cleaved to 4-aminosalicylic acid and sulfapyridine (18). This reduction is mediated by anaerobic bacteria in the intestine, and it leads to the formation of two agents that are pharmacologically active in the treatment of ulcerative colitis. 

Hebden JM, Perkins AC, Frier M, Wilson CG, Spiller RC. Limited exposure of left colon to daily dosed oral formulation in active distal ulcerative colitis explanation of poor response to treatment . Gut 1997 40 28A. 

A medicinal example is found with 5-aminosalicylic acid O-sulfate (5-ASA sulfate, 9.90). 5-ASA is an agent for the treatment of ulcerative colitis and Crohn s disease of the large intestine, but it is unstable in the gastric juice. 5-ASA sulfate was, therefore, developed as a prodrug able to reach its site of action (the colon) following oral application [173]. In healthy human... 

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