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Lancet (London, England) Apr 2017Ulcerative colitis is a chronic inflammatory disease affecting the colon, and its incidence is rising worldwide. The pathogenesis is multifactorial, involving genetic... (Review)
Review
Ulcerative colitis is a chronic inflammatory disease affecting the colon, and its incidence is rising worldwide. The pathogenesis is multifactorial, involving genetic predisposition, epithelial barrier defects, dysregulated immune responses, and environmental factors. Patients with ulcerative colitis have mucosal inflammation starting in the rectum that can extend continuously to proximal segments of the colon. Ulcerative colitis usually presents with bloody diarrhoea and is diagnosed by colonoscopy and histological findings. The aim of management is to induce and then maintain remission, defined as resolution of symptoms and endoscopic healing. Treatments for ulcerative colitis include 5-aminosalicylic acid drugs, steroids, and immunosuppressants. Some patients can require colectomy for medically refractory disease or to treat colonic neoplasia. The therapeutic armamentarium for ulcerative colitis is expanding, and the number of drugs with new targets will rapidly increase in coming years.
Topics: Colectomy; Colitis, Ulcerative; Colonoscopy; Diagnosis, Differential; Glucocorticoids; Humans; Immunosuppressive Agents; Mesalamine; Prognosis; Remission Induction
PubMed: 27914657
DOI: 10.1016/S0140-6736(16)32126-2 -
Lancet (London, England) Nov 2012Ulcerative colitis is an idiopathic, chronic inflammatory disorder of the colonic mucosa, which starts in the rectum and generally extends proximally in a continuous... (Review)
Review
Ulcerative colitis is an idiopathic, chronic inflammatory disorder of the colonic mucosa, which starts in the rectum and generally extends proximally in a continuous manner through part of, or the entire, colon; however, some patients with proctitis or left-sided colitis might have a caecal patch of inflammation. Bloody diarrhoea is the characteristic symptom of the disease. The clinical course is unpredictable, marked by alternating periods of exacerbation and remission. In this Seminar we discuss the epidemiology, pathophysiology, diagnostic approach, natural history, medical and surgical management, and main disease-related complications of ulcerative colitis, and briefly outline novel treatment options. Enhanced understanding of how the interaction between environmental factors, genetics, and the immune system results in mucosal inflammation has increased knowledge of disease pathophysiology. We provide practical therapeutic algorithms that are easily applicable in daily clinical practice, emphasising present controversies in treatment management and novel therapies.
Topics: Algorithms; Anti-Inflammatory Agents, Non-Steroidal; Colitis, Ulcerative; Colonic Pouches; Humans; Mesalamine; Proctocolectomy, Restorative
PubMed: 22914296
DOI: 10.1016/S0140-6736(12)60150-0 -
Deutsches Arzteblatt International Aug 2020Ulcerative colitis is a chronic inflammatory bowel disease with an estimated 150 000 patients in Germany alone. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Ulcerative colitis is a chronic inflammatory bowel disease with an estimated 150 000 patients in Germany alone.
METHODS
This review is based on publications about current diagnostic and therapeutic strategies for ulcerative colitis that were retrieved by a selective search in PubMed, and on current guidelines.
RESULTS
The primary goal of treatment is endoscopically confirmed healing of the mucosa. Mesalamine, in various forms of administration, remains the standard treatment for uncomplicated ulcerative colitis. Its superiority over placebo has been confirmed in meta-analyses of randomized, controlled trials. Glucocorticoids are highly effective in the acute treatment of ulcerative colitis, but they should only be used over the short term, because of their marked side effects. Further drugs are available to treat patients with a more complicated disease course of ulcerative colitis, including azathioprine, biological agents, JAK inhibitors (among them TNF antibodies, biosimilars, ustekinumab, vedolizumab, and tofacitinib), and calcineurin inhibitors. Proctocolectomy should be considered in refractory cases, or in the presence of high-grade epithelial dysplasia. Ulcerative colitis beginning in childhood or adolescence is often characterized by rapid progression and frequent comorbidities that make its treatment a special challenge.
CONCLUSION
A wide variety of drugs are now available for the treatment of ulcerative colitis, enabling the individualized choice of the best treatment for each patient. Regular surveillance colonoscopies to rule out colon carcinoma should be scheduled at intervals that depend on risk stratification.
Topics: Adolescent; Algorithms; Biosimilar Pharmaceuticals; Child; Colitis, Ulcerative; Germany; Humans; Mesalamine
PubMed: 33148393
DOI: 10.3238/arztebl.2020.0564 -
Clinical Medicine (London, England) Mar 2021Ulcerative colitis is a relapsing and remitting disease that is increasing in incidence and prevalence. Management aims to achieve rapid resolution of symptoms, mucosal...
Ulcerative colitis is a relapsing and remitting disease that is increasing in incidence and prevalence. Management aims to achieve rapid resolution of symptoms, mucosal healing and improvement in a patient's quality of life. 5-aminosalicylate acid medications remain the first-line treatment for mild to moderate disease. In the event of suboptimal response to these medications, escalation to immunosuppressive medications and biologics may be necessary. Importantly, despite best medical therapy, surgery may be required in a proportion of patients. The future will likely see an array of new therapeutic options for those with ulcerative colitis with the potential for a more personalised treatment approach.
Topics: Colitis, Ulcerative; Humans; Quality of Life
PubMed: 33762374
DOI: 10.7861/clinmed.2021-0080 -
Journal of Medicine and Life 2019Ulcerative colitis (UC) and Crohn's disease (CD) are classified as chronic inflammatory bowel diseases (IBD) which have similar symptoms and lead to digestive disorders... (Review)
Review
Ulcerative colitis (UC) and Crohn's disease (CD) are classified as chronic inflammatory bowel diseases (IBD) which have similar symptoms and lead to digestive disorders and inflammation in the digestive system. The reason why they occur is still a mystery. A number of factors can be attributed to the prevalence of CD and UC, some of which include geographical location, inappropriate diet, genetics, and inappropriate immune response. Both diseases are more often diagnosed in urban areas compared to rural areas and both have their own challenges and side effects, but the patients can still have a good quality of life. Given the fact that the prevalence of this disease is higher at younger ages and that it disrupts half the life of the patient, it will, most likely, become a major health problem in the near future, even in developing countries. By reviewing valid scientific resources and evaluating new methods of addressing this disease, the present study aims to provide researchers and patients with new insights into this field and facilitate access to new treatments.
Topics: Colitis, Ulcerative; Crohn Disease; Diet; Humans; Inflammatory Bowel Diseases; Prevalence; Quality of Life
PubMed: 31406511
DOI: 10.25122/jml-2018-0075 -
F1000Research 2020Inflammatory bowel diseases are common, complex, immune-mediated conditions with a sharply rising global prevalence. While major advances since 2000 have provided strong... (Review)
Review
Inflammatory bowel diseases are common, complex, immune-mediated conditions with a sharply rising global prevalence. While major advances since 2000 have provided strong mechanistic clues implicating a de-regulation in the normal interaction among host genetics, immunity, microbiome, and the environment, more recent progress has generated entirely new hypotheses and also further refined older disease concepts. In this review, we focus specifically on these novel developments in the pathogenesis of ulcerative colitis.
Topics: Colitis, Ulcerative; Female; Humans; Immunity; Male; Microbiota
PubMed: 32399194
DOI: 10.12688/f1000research.20805.1 -
Digestion 2020Patient care in ulcerative colitis (UC) remains challenging despite an array of established treatment options and emerging new therapies. The management of UC therapy... (Review)
Review
BACKGROUND
Patient care in ulcerative colitis (UC) remains challenging despite an array of established treatment options and emerging new therapies. The management of UC therapy should be guided by the endoscopic extent of inflammation, disease severity, and prognostic factors of poor outcome. Complete remission, defined as durable symptomatic and endoscopic remission without corticosteroid therapy, is the desired treatment goal.
SUMMARY
This review focuses on treatment recommendations for different clinical scenarios in moderate-to-severe UC: Active UC of any extent not responding to aminosalicylates, steroid-dependent UC, steroid-refractory UC, immunomodulator-refractory UC, and acute severe UC. Comprehensive treatment algorithms for daily clinical practice were developed based on published guidelines and current literature. Key Messages: While current treatment options including a number of biologicals and small molecules have evolved UC treatment to achieve sustained remission in a majority of patients, upcoming treatment options with different molecular pathways and different modes of actions will further increase the need for personalized medicine.
Topics: Algorithms; Colitis, Ulcerative; Humans; Inflammation; Remission Induction; Severity of Illness Index; Treatment Outcome
PubMed: 31945767
DOI: 10.1159/000504092 -
Nutrients Jun 2019Epidemiological and experimental studies have suggested that diet is one of the environmental factors that contributes to the onset and pathophysiology of ulcerative... (Review)
Review
Epidemiological and experimental studies have suggested that diet is one of the environmental factors that contributes to the onset and pathophysiology of ulcerative colitis. Although many patients suffering from ulcerative colitis attribute their symptoms or disease relapse to dietary factors, only a few well-designed randomized controlled trials have been done to investigate the role of diet in the management of ulcerative colitis. Here, we review the potential mechanisms of the relationship between diet and pathogenesis of ulcerative colitis and summarize randomized controlled dietary interventions that have been conducted in ulcerative colitis patients.
Topics: Colitis, Ulcerative; Colon; Diet; Humans; Randomized Controlled Trials as Topic; Risk Factors; Treatment Outcome
PubMed: 31262022
DOI: 10.3390/nu11071498 -
American Family Physician May 2013Ulcerative colitis is a chronic inflammatory disease of the colon. The etiology is unknown. Risk factors include a history of recent infection with Salmonella or... (Review)
Review
Ulcerative colitis is a chronic inflammatory disease of the colon. The etiology is unknown. Risk factors include a history of recent infection with Salmonella or Campylobacter, living in Western industrialized nations and at higher latitudes, and a family history of the disease. The incidence peaks in early adulthood, but patients can develop the disorder from early childhood through adulthood. Ulcerative colitis often presents with abdominal pain, diarrhea, and hematochezia. It is important to exclude infectious etiologies. Anemia and an elevated erythrocyte sedimentation rate or C-reactive protein level may suggest inflammatory bowel disease, but the absence of laboratory abnormalities does not rule out ulcerative colitis. The diagnosis is suspected clinically and confirmed through endoscopic biopsy. First-line treatment is therapy with 5-aminosalicylic acid. Corticosteroids may be added if 5-aminosalicylic acid therapy is ineffective. Infliximab can be added to induce and sustain remission. Patients with severe or nonresponsive ulcerative colitis should be hospitalized, and intravenous corticosteroids should be given. If medical management has been ineffective, surgical intervention is indicated for severe disease. Patients with ulcerative colitis have an increased risk of colon cancer and should have periodic colonoscopy beginning eight to 10 years after diagnosis.
Topics: Colitis, Ulcerative; Diagnosis, Differential; Humans; Risk Factors
PubMed: 23939448
DOI: No ID Found -
EBioMedicine Dec 2021The mucin2 (MUC2) mucus barrier acts as the first barrier that prevents direct contact between intestinal bacteria and colonic epithelial cells. Bacterial factors... (Review)
Review
The mucin2 (MUC2) mucus barrier acts as the first barrier that prevents direct contact between intestinal bacteria and colonic epithelial cells. Bacterial factors related to the MUC2 mucus barrier play important roles in the response to changes in dietary patterns, MUC2 mucus barrier dysfunction, contact stimulation with colonic epithelial cells, and mucosal and submucosal inflammation during the occurrence and development of ulcerative colitis (UC). In this review, these underlying mechanisms are summarized and updated, and related interventions for treating UC, such as dietary adjustment, exogenous repair of the mucus barrier, microbiota transplantation and targeted elimination of pathogenic bacteria, are suggested. Such interventions are likely to induce and maintain a long and stable remission period and reduce or even avoid the recurrence of UC. A better mechanistic understanding of the MUC2 mucus barrier and its related bacterial factors may help researchers and clinicians to develop novel approaches for treating UC.
Topics: Anti-Bacterial Agents; Colitis, Ulcerative; Combined Modality Therapy; Dietary Supplements; Fecal Microbiota Transplantation; Gastrointestinal Microbiome; Humans; Intestinal Mucosa; Mucin-2
PubMed: 34902790
DOI: 10.1016/j.ebiom.2021.103751