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Medical management of ulcerative colitis


Rogler, G (2009). Medical management of ulcerative colitis. Digestive Diseases, 27(4):542-549.

Abstract

Ulcerative colitis (UC) is a chronic and relapsing inflammation limited to the colonic mucosa and always involving the rectum with variable extension towards the cecum. The aim of medical treatment is to induce and maintain clinical remission. In contrast to Crohn's disease for which a 'top-down' or 'early aggressive' therapy is discussed, in UC the concept of a step-up treatment is still valid. This step-up approach includes local or systemic administration of 5-aminosalicylic acid as first-line therapy followed by topical or systemic steroid administration as well as azathioprine, 6-mercaptopurine, cyclosporine, and more recently anti-tumor necrosis factor monoclonal antibodies as options in refractory or chronic active disease. Colectomy may be necessary if medical treatments are unsuccessful or if complications develop. The decision about the individual therapy of UC is dependent on both disease activity and on disease location. Different therapy strategies are applied in ulcerative proctitis, left-sided colitis, pancolitis and fulminant colitis as well as in chronic active disease and maintenance of remission. This overview presents important concepts in the treatment of UC based on the published guidelines.

Abstract

Ulcerative colitis (UC) is a chronic and relapsing inflammation limited to the colonic mucosa and always involving the rectum with variable extension towards the cecum. The aim of medical treatment is to induce and maintain clinical remission. In contrast to Crohn's disease for which a 'top-down' or 'early aggressive' therapy is discussed, in UC the concept of a step-up treatment is still valid. This step-up approach includes local or systemic administration of 5-aminosalicylic acid as first-line therapy followed by topical or systemic steroid administration as well as azathioprine, 6-mercaptopurine, cyclosporine, and more recently anti-tumor necrosis factor monoclonal antibodies as options in refractory or chronic active disease. Colectomy may be necessary if medical treatments are unsuccessful or if complications develop. The decision about the individual therapy of UC is dependent on both disease activity and on disease location. Different therapy strategies are applied in ulcerative proctitis, left-sided colitis, pancolitis and fulminant colitis as well as in chronic active disease and maintenance of remission. This overview presents important concepts in the treatment of UC based on the published guidelines.

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Additional indexing

Item Type:Journal Article, refereed, further contribution
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Gastroenterology and Hepatology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2009
Deposited On:16 Mar 2010 14:31
Last Modified:07 Dec 2017 01:38
Publisher:Karger
ISSN:0257-2753
Additional Information:© 2010 S. Karger AG
Publisher DOI:https://doi.org/10.1159/000233295
PubMed ID:19897972

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