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Questions and Answers
Which treatment is typically recommended as first-line therapy for mild-moderate distal ulcerative colitis?
What is the appropriate pharmacologic treatment option for proctitis in ulcerative colitis?
In patients with moderate-severe ulcerative colitis who do not respond to prednisone, what alternative treatments may be considered?
What is the site of disease for extensive colitis in ulcerative colitis?
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What is the first-line therapy for mild-moderate extensive ulcerative colitis in active disease?
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Which of the following is NOT an appropriate remission/maintenance therapy for mild-moderate distal UC?
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For severe-fulminant ulcerative colitis refractory to IV corticosteroids, what treatment could be considered next?
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What is the appropriate pharmacologic treatment option for pancolitis in ulcerative colitis?
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What is the recommended pharmacologic approach for refractory ulcerative colitis after attempting IV cyclosporine therapy?
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Which treatment option should be considered for maintenance therapy in UC after achieving remission with IV hydrocortisone?
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Study Notes
Inflammatory Bowel Disease (IBD)
- IBD is a chronic GI condition characterized by inflammation of the gut, including Ulcerative Colitis (UC) and Crohn's Disease (CD)
- UC is a type of IBD characterized by chronic inflammation of the colon
Ulcerative Colitis (UC)
- Definition: UC is a chronic inflammation of the colon, characterized by rectal bleeding, diarrhea, and abdominal pain
- Epidemiology:
- Prevalence: 10% worldwide among adults
- More predominant in younger patients and women
- Pathophysiology:
- Results from altered somatovisceral and motor dysfunction of the intestine
- Abnormal CNS processing of afferent signals may lead to visceral hypersensitivity
- Factors contributing to alterations include genetics, motility, inflammation, colonic infections, mechanical irritation, stress, and psychological factors
Treatment of UC
- Treatment is based on:
- Type of UC (UC vs CD)
- Severity (Mild, Moderate, Severe, Fulminant)
- Site of disease (Proctitis, Distal disease, Extensive disease, Small intestine involvement)
- Need for acute treatment or maintenance therapy
- Treatment options:
- Topical agents (suppository) for proctitis
- Systemic or topical therapy or combination for distal disease
- Systemic agents for extensive colitis
- May add topical therapy if needed/appropriate
- Mild-Moderate Distal UC:
- First-line treatment: Topical aminosalicylates (enema/suppository)
- Mesalamine if inadequate or no response
- May combine oral and topical aminosalicylates
- Mild-Moderate Extensive UC:
- First-line treatment: Oral aminosalicylate
- Budesonide (Uceris) 9 mg/d
- Sulfasalazine or Mesalamine
- Moderate-Severe UC:
- First-line treatment: Budesonide 9 mg/day
- Prednisone 40-60 mg/d
- Add azathioprine, mercaptopurine, infliximab, adalimumab, or golimumab if no response
- Severe-Fulminant UC:
- Treatment: Methylprednisolone 40-60 mg daily for 3-5 days
- IV cyclosporine or infliximab if refractory to IV corticosteroids
- Add azathioprine, mercaptopurine, infliximab, certolizumab, adalimumab, vedolizumab or tofacitinib if remission achieved
- Attempt to withdraw prednisone after 1-2 months
Irritable Bowel Syndrome (IBS)
- Definition: IBS is a GI syndrome characterized by chronic abdominal pain and altered bowel habits in the absence of any organic cause
- Epidemiology:
- Prevalence: 10% worldwide among adults
- More predominant in younger patients and women
- Pathophysiology:
- Results from altered somatovisceral and motor dysfunction of the intestine
- Abnormal CNS processing of afferent signals may lead to visceral hypersensitivity
- Factors contributing to alterations include genetics, motility, inflammation, colonic infections, mechanical irritation, stress, and psychological factors
Treatment of IBS
- Treatment options:
- Linaclotide
- Rifaximin
- Tegaserod
- Plecanatide
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Description
Test your knowledge of pharmacotherapy options for inflammatory bowel disease with this quiz. Learn about medications such as Linaclotide, Rifaximin, Tegaserod, and Plecanatide referenced in the 'DiPiro's Pharmacotherapy: A Pathophysiologic Approach' textbook.
