Inflammatory bowel disease - Ulcerative colitis (UC)

27 important questions on Inflammatory bowel disease - Ulcerative colitis (UC)

Are fistulas/strictures common in UC?

No.

Where is UC located?

Colon, especially the rectum

What is the depth of UC?

Superficial
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What is the pattern of UC?

Continuous

What is used to treat distal disease?

Topical (rectal) treatments

With the exception of steroids, can the treatment options used for induction be continued for maintenance of remission?

Yes

What can be used for induction in mild UC?

Mesalamine with or w/o a steroid

For mild distal UC, what is preferred?

Rectal mesalamine

For mild extensive UC, what is preferred?

Rectal +/- PO mesalamine

What is used for maintenance therapy of mild disease UC?

Aminosalicysaltes

What can be used for induction in moderate to severe UC?

A biologic with or w/o immunomodulator

What is recommended for maintenance of moderate-severe UC?

Immunosuppressive meds (thiopurines, anti-TNF drugs)

1st line (preferred) treatments for moderate-severe disease

1. Anti-TNF with or w/o thiopurine
2. IL receptor antagonist
3. Integrin receptor antagonist

2nd line (alternatives) for moderate-severe UC

1. Janus kinase (JAK) inhibitor
2. Oral sphingosine-1-phosphate receptor modulator

Rectal steroids are only indicated for what?

UC only

Budesonide rectal foam only for UC?

Uceris

What are the 2 rectal steroid foams?

Hydrocortisone
Budesonide (Uceris)

What are the available aminosalacylates used for induction?

Mesalamine
Sulfasalazine
Balsalazide

Mesalamine ER capsules for induction and maintenance

Pentasa

Mesalamine ER tablets for induction and maintenance

Asacol HD

Mesalamine enema for induction and maintenance

Rowasa retain in rectum overnight

Mesalamine suppository for induction

Canasa retain for at least 1-3 hours

What are the allergy contraindications for Sulfasalazine?

Sulfa and salicylate allergies

Interleukin receptor antagonist only for UC

Mirikizumab-mrkz (Omvoh)

What is an immunosuppressive drug reserved for severe acute UC refractory to steroids?

Cyclosporine

What are the two sphingosine-1-phosphate receptor modulators for UC?

1. Ozanimod (Zeposia)
2. Etrasimod (Velsipity)

Which Integrin receptor antagonist can be used in both UC and CD?

Vedolizumab (Entyvio) injection

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