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• W2363726103 abstract "In recent years, the advances in therapy of ulcera-tive colitis (UC) have been characterized mainly by the more extensive use of immunosuppression. Cy-closporin (CSA) may become a drug of choice to treat severe UC, but its long-term effect is insufficient. Topically, glucocorticosteroids (GCS) are hopeful in right ileocolonic UC, but no action for maintenance therapy[1-3]. The most significant development in recent years is the introduction of im-munomodulatory treatments using cytokines and an-ticytokines. Immunomodulation therapy creates great expectations since early reset of the immunos-tat might be able to control inflammation in a long term. Current treatment strategies are anti-inflam-matory and to modulate the immune response. Stan-dard therapies with sulphasalazine (SAS) or 5-aminosalicylic acids ( 5-ASA, mesalazine or mesalamine), GCS and antibiotics yield a fair im-mediate success, but long-term response to these therapies is poor. The greatest advance has been the introduction of immunosuppressive strategies. The indexes like the clinical activity index (CAI) proposed by Rachmilewitz[1], although useful, have not received general acknowledgement.Patients with an inflammatory bowel disease (IBD), such as UC or Crohn’s disease, have recur-rent symptoms with high morbidity. Mild disease requires only sympt omatic relief and dietary manipu-lation. Mild to moderate disease can be managed with 5-ASA, including olsalazine and mesalamine. Mesalamine enemas and suppositories are useful in treating proctosigmoiditis. Corticosteroids are beneficial in patients with more severe symptoms, but side effects limit their use, particularly for chronic therapy. Immunosuppressant therapy may be considered in patients with refractory disease that is not amenable to surgery. IBD in pregnant women can be managed with 5-ASA and corticosteroids[2]. Since longstanding IBD is associated with an increased risk of colon cancer, periodic colonoscopy is warranted.Since lesions in UC are quite diffuse and uniform endoscopic indexes used are quite straightfor-ward, clinical activity, endoscopic activity and his-tology show a reasonable correlation and it is useful to monitor disease activity also with flexible proc-tosigmoidoscopy. The persistence of active inflam-matory lesions at histology in the presence of endo-scopic remission predicts relapse. Bresci G et al[3] reported that the activity of the disease was evaluated by a Clinical Activity Index and an Endoscopic Index. Of 112 cases of UC observed, 95 showed no change in extent and were studied as examples of non-progressive UC, and in this group the extension of the disease was: pancolitis in 19%, left sided col-itis in 39%, proctosigmoiditis in 17% and proctitis in 25%. A colectomy had to be performed in 5%. None of the enrolled cases developed a cancer dur-ing the follow up. The patients with ulcerative pancolitis or left-sided colitis were treated with 5-ASA-1.6g/d in a delayed-release formulation, while the patients with proctosigmoiditis or proctitis were treated with 5-ASA enem as 4 g/d. The patients with more than one relapse/ year accounted for 39%. The proportion of patients with only one relapse/ year was 53%. The patients with steady re-mission for all the seven years of the trial were only 8%, but with a statistically significant difference between the groups with initial diagnosis of proc-tosigmoiditis or proctitis and the group with initial diagnosis of pancolitis or left-sided colitis (12% vs 5%). Among the patients with continuous remis-sion, 37% showed colonic alterations, with an en-doscopic score higher than 4 but a clinical score less than 6. Side effects were observed in 6% of patients but without treatment withdrawal. Non-progressive UC throughout the colon has a relatively good prog-nosis, which seems to be independent of the location of the disease, even if Bresci G et al[3] have found a statistically significant higher percentage of patients with steady remission among the patients with more distal diseases." @default.
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• W2363726103 date "1999-01-01" @default.
• W2363726103 modified "2023-09-27" @default.
• W2363726103 title "Current medical therapy for ulcerative colitis" @default.
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