ULCERATIVE COLITIS

INTRODUCTION Ulcerative colitis is a disease that causes

inflammation and sores, called ulcers, in the lining of the rectum and colon

The 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 experience

anemia fatigue weight loss loss of appetite rectal bleeding loss of body fluids and nutrients skin lesions joint pain growth failure (specifically in children)

SYMPTOMS

DIAGNOSIS Many 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 suggested

1. GENITIC FACTORS2. ENVIRONMENTAL FACTORS3. AUTO IMMUNE DISEASE4. ALTERNATIVE THEORIES

CLINICAL PRESENTATION

GI SYMPTOMSEXTENT OF INVOLVMENT

SEVIERITY OF DISEASEEXTRAINTISTINAL FEATURES

TREATMENTDRUG THERAPY

AMINO SALICYLATESCORTICOSTEROIDS IMMUNO SUPRESSIVE DRUGSBIOLOGIC TREATMENT

SURGERYOTHER SURGICAL ALTERNATIVES

DIETBACTERIAL RE COLONIGATION

AMINOSALICYLATESMESALAZINEMECHANISM ACTION

These include the inhibition of cyclo-oxygenase, lipoxygenase, platelet-activating factor, interleukin-1, nuclear factor κB, 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,

24–96-h urinary excretion of total 5-ASA and faecal excretion

COURSE AND COMPLICATIONS•Patients 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 therapy

•Patients with more extensive disease are less likely to sustain remission, but the rate of remission is independent of the severity of disease.

ONGOING RESEARCH

Recent evidence from the ACT-1 trial suggests that infliximab may have a greater role in inducing and maintaining disease remission

An 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

THAN

K

YOU