Post on 10-Feb-2017
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INTRODUCTIONUlcerative colitis is a disease that causes inflammation and sores, called ulcers, in the lining of the rectum and colonThe main symptom of active disease is usually constant diarrhea mixed with blood, of gradual onset. is a form of inflammatory bowel disease (IBD). Ulcerative colitis is a form of colitis, a disease of the intestine, specifically the large intestine or colon, that includes characteristic ulcers, or open sores, in the colon
The most common symptoms of ulcerative colitis are abdominal pain and bloody diarrhea. Patients also may experienceanemia fatigue weight loss loss of appetite rectal bleeding loss of body fluids and nutrients skin lesions joint pain growth failure (specifically in children)
DIAGNOSISMany tests are used to diagnose ulcerative colitis. A physical exam and medical history are usually the first step.Blood tests may be done to check for anemia, which could indicate bleeding in the colon or rectum . In addition, a stool sample allows the doctor to detect bleeding or infection in the colon or rectum caused by bacteria, a virus, or parasites.
CAUSES While the cause of ulcerative colitis is still unknown, several, possibly interrelated, causes have been suggested1. GENITIC FACTORS2. ENVIRONMENTAL FACTORS3. AUTO IMMUNE DISEASE4. ALTERNATIVE THEORIES
CLINICAL PRESENTATIONGI SYMPTOMSEXTENT OF INVOLVMENTSEVIERITY OF DISEASEEXTRAINTISTINAL FEATURES
TREATMENTDRUG THERAPYAMINO SALICYLATESCORTICOSTEROIDSIMMUNO SUPRESSIVE DRUGSBIOLOGIC TREATMENTSURGERYOTHER SURGICAL ALTERNATIVESDIETBACTERIAL RE COLONIGATION
AMINOSALICYLATESMESALAZINEMECHANISM ACTION These include the inhibition of cyclo-oxygenase, lipoxygenase, platelet-activating factor, interleukin-1, nuclear factor B, tumour necrosis factor activation, B cells and oxygen radical production, and a scavenger of reactive oxygen species
PHARMACOKINETICSThe range of urinary excretion for the azo-bond compounds and Asacol ranged between 10% and 35%,for Pentasa, between 15% and 53%, and, for Salofalk /Claversal/Mesasal, between 27% and 56%.all compounds showed comparable ranges of systemic absorption of total 5-ASA based on plasma pharmacokinetics,2496-h urinary excretion of total 5-ASA and faecal excretion
COURSE AND COMPLICATIONSPatients with proctitis or left-sided colitis usually have a more benign course: only 15% progress proximally with their disease, and up to 20% can have sustained remission in the absence of any therapyPatients with more extensive disease are less likely to sustain remission, but the rate of remission is independent of the severity of disease.
ONGOING RESEARCHRecent evidence from the ACT-1 trial suggests that infliximab may have a greater role in inducing and maintaining disease remissionAn increased amount of colonic sulfate-reducing bacteria has been observed in some patients with ulcerative colitis, resulting in higher concentrations of the toxic gas hydrogen sulfide. The role of hydrogen sulfide in pathogenesis is unclear