Management and treatment of distal ulcerative colitis

  • Andrea Calafiore | calafiore.a@gmail.com Department of Clinical Medicine, IBD unit, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
  • Chiara Praticò Department of Clinical Medicine, IBD Unit, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
  • Fernando Rizzello Department of Clinical Medicine, IBD Unit, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
  • Carlo Calabrese Department of Clinical Medicine, IBD Unit, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
  • Donatella Riso Department of Clinical Medicine, IBD Unit, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
  • Paolo Gionchetti Department of Clinical Medicine, IBD Unit, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
  • Chiara Valerii Department of Clinical Medicine, IBD Unit, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
  • Massimo Campieri Department of Clinical Medicine, IBD Unit, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.

Abstract

Ulcerative colitis (UC) is a chronic inflammatory condition that is confined to the colonic mucosa. Its main symptoms include diarrhea, rectal bleeding and abdominal pain. Approximately two-thirds of UC patients have disease confined distal to the splenic flexure, which can be treated effectively with topical therapy. This means the active drug can be delivered directly to the site of inflammation, limiting the systemic absorption and potential side effects. Topical treatment with aminosalicylates is the most effective approach in the treatment of these forms, provided that the formulation reaches the upper margin of the disease. Given this, the suppository formulation is the treatment of choice for proctitis and distal sigmoiditis. Thanks to their proximal spread, enemas, foams and gels represent the treatment of choice for proctosigmoiditis and for distal ulcerative colitis. Oral aminosalicylates are less effective than topical therapies in patients with active disease, while the combination of topical and oral treatment is more effective in patients refractory to topical or oral mono-therapy. Topically administered aminosalicylates play an important role in the maintenance of remission, but the long-term adhesion to therapy is poor. For this reason, the oral formulation is the first-line therapy in the maintenance of remission. Refractory patients can be treated with topical steroids or systemic steroids and TNF-alpha inhibitors in severe forms.

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Published
2013-12-17
Section
Reviews
Keywords:
ulcerative colitis, 5-ASA, aminosalicylates, refractory, steroids, infliximab.
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How to Cite
Calafiore, A., Praticò, C., Rizzello, F., Calabrese, C., Riso, D., Gionchetti, P., Valerii, C., & Campieri, M. (2013). Management and treatment of distal ulcerative colitis. Italian Journal of Medicine, 7(4), 265-271. https://doi.org/10.4081/itjm.2013.265

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