Ulcerative colitis
Can affect the region from the rectum to the whole colon
Symptoms
bloody diarrhoea
defecation urgency abdominal pain
May lead to complications such as:
Colorectal cancer
Secondary osteoporosis
Venous thromboembolism
Toxic megacolon
Most common in
15-25 yo
Types of UC
increased inflammation:
Proctitis - rectum
Proctosigmoiditis - rectum + sigmoid colon
Distal/left sided - colon distal to the splenic flexure
Extensive colitis - colon proximal to the splenic flexure
Pacholitis - whole colon
Difference between UC and CD
UC has a continuous pattern, CD is patchy
Treatment - Acute (mild - moderate) DISTAL general
Rectal preparation (suppositories or enemas)
* Foam preparations used if patient has difficulty retaining liquid enema
Treatment - Acute (mild - moderate) EXTENDED general
Systemic medication needed
Diarrhoea treatment
Avoid loperamide or codeine as this can cause toxic megacolon
* Only to be initiated under specialist advice
Toxic megacolon
Widespread infection
Slows down gastric emptying
Build up in colon
Treatment - acute (mild to moderate) PROCTITIS
- Topical aminosalicylate
- no improvement 4 weeks = add PO aminosalicylate
- Inadequate response = add PO/T CS (4-8 weeks)
Alt to topical aminosalicylate
1. PO aminosalicylate
2. Inadequate response = add PO/T CS (4-8 weeks)
Alt to PO aminosalicylate
1. PO/T CS (4-8 weeks)
Treatment - acute (mild to moderate) PROCTOSIGMOIDITIS + LEFT SIDED UC
- topical aminosalicylate
- no improvement after 4 weeks = add high dose PO aminosalicylate (alternative = switch to high dose PO aminosalicylate + 4-8 weeks of topical CS)
- Inadequate response = Stop topical treatment and offer PO aminosalicylate + 4-8 weeks of PO CS
Alt=
Monotherapy with a high-dose oral aminosalicylate (may not be as effective)
No improvement after 4 weeks = add PO CS for 4 to 8 weeks
Treatment - acute (mild to moderate) EXTENSIVE
- topical + high dose PO aminosalicylate
- No improvement after 4 weeks = stop topical and offer high dose PO aminosalicylate + PO CS for 4-8 weeks
if aminosalicylate CI - PO CS for 4-8 weeks
Treatment - acute (severe)
Life-threatening
MEDICAL EMERGENCY
* IV hydrocortisone or methylprednisolone and assess for need of surgery
* If IV steroids CI → use IV ciclosporin or surgery
- No improvement in 72 hours → IV steroid + IV ciclosporin (infliximab) or surgery
- Surgery
Treatment - maintenance
- Oral aminosalicylates recommended
- CS not suitable due to side-effects
- More effective as once daily dose - however may cause more side-effects
Proctitis or proctosigmoiditis: maintenance
- PR +/- PO aminosalicylates
- PO can be given alone if PR is not wanted
Left-sided or extensive: maintenance
Low dose PO aminosalicylate
> 2+ Flares in 12-months:
PO azathioprine or mercaptopurine
Give monoclonal antibodies if no effect
Aminosalicylates - examples
Sulfasalazine Balsalazide Mesalazine Olsalazine
Aminosalicylates - side effects
Nephrotoxic: monitor before initiation, at 3 months, then annually
Hepatotoxic: monitor at monthly intervals for first 3 months
Blood disorders: monitor at monthly intervals for first 3 months
Sulfasalazine: stains contact lenses orangey-yellow
Colour change
Renal impairment
Oligozoospermia
Hypersensitivity reactions
Neutropenia/blood dyscrasias
Skin reactions
Aminosalicylates - CI
salicylate hypersensitivity
Aminosalicylates - blood dyscrasia
Perform blood count and stop drug immediately if signs of a blood dyscrasia
o patients advised to report: unexplained bleeding; bruising; sore throat; fever
