| Abstract: |
The goal of treatment for ulcerative colitis (UC, a type of inflammatory bowel disease) is the induction and maintenance of remission of symptoms and mucosal inflammation. About two-thirds of patients with ulcerative colitis have an inflammatory involvement distal to the splenic flexure, and therefore may be effectively treated with topical treatment (administered through the rectum). This allows the delivery of the active drug directly to the site of inflammation and limits systemic absorption and potential side-effects. Topical aminosalicylate therapy is the most effective approach, and most patients will benefit hugely, provided that the formulation reaches the upper extent of the disease. This article outlines this type of treatment and also reviews the management of problematic proctitis. The author cautions that oral aminosalicylates are less effective than topical therapies; however, a combination of oral and topical aminosalicylates can be successful in refractory patients. Alternatives to aminosalicylates are the new glucocorticoids, budesonide and beclometasone dipropionate, either as enemas or oral formulations (only beclometasone dipropionate). Additional treatments include oral steroids, short-chain fatty acid enemas, nicotine enemas and patches, acetarsol suppositories, cyclosporin enemas, and epidermal growth factor enemas. The factors that can prevent a positive therapeutic response include concurrent enteric pathogens, coexistent irritable bowel syndrome, patient nonadherence to therapy, inadequate dosing and duration of therapy, and proximal progression of the disease. The author concludes that surgical colectomy may be required in those rare patients refractory or intolerant to pharmacotherapy. 36 references. |