What is UC
Ulcerative colitis (UC) is a chronic relapsing and remitting inflammatory condition of the large intestine. (Inflammation is a localized protective reaction of tissue to irritation, injury, or infection. It is characterized by pain, redness, swelling, and sometimes loss of function.)

Ulcerative means a loss of the surface lining, and colitis means inflammation of that lining or mucosa. The inflammation is caused by an abnormal invasion of white blood cells into the mucosa. The exact cause of this attack is not known, but it is thought that a combination of genetic and environmental factors causes the immune system to react aggressively against the normal bacteria that inhabit the colon...

Comprehensive Patient Care in the Treatment of Ulcerative Colitis

Marc Bradette, MD, FRCPC, CSPQ, Clinical Professor, Department of Gastroenterology, Pavillon Hôtel-Dieu de Québec, Québec, QC.

The Patient with Newly Diagnosed Ulcerative Colitis

Publication of THE LATEST IN ULCERATIVE COLITIS CARE supplement was made possible by an unrestricted educational grant from Aptalis Pharma

¹James Gregor, MD,²Co-authors: John Howard, MD, Nitin Khanna, MD, and Nilesh Chande, MD,

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Abstract: Informed patients are one of the most important assets available in the management of patients with ulcerative colitis. Clinical experience reinforces that most patients have similar questions upon diagnosis. Anticipating these questions and tailoring them to a particular patient's disease severity and extent should not only streamline follow-up but also mitigate confusion and augment the benefit of the plethora of information available in the 21st century. Using our local experience, we have defined the 10 most common questions asked by patients and modified the answers, where necessary, to improve their specificity to patients with ulcerative proctitis, left-sided ulcerative colitis, and pancolitis.

Key Words: ulcerative colitis, patient, questions, classification, management.

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Patients can be relatively ill informed regarding the nature of their UC, its management, and its ultimate prognosis.

Generally, disease extent is divided into three categories: ulcerative proctitis, left-sided disease, and pancolitis.

A simple approach with frequently asked questions (FAQs) is a highly desirable and efficient means of transmitting information.

Clinical experience reinforces that most patients have similar questions upon diagnosis with UC.

Anticipating these questions and tailoring them to a particular patient's disease severity and extent should streamline follow-up and also mitigate confusion.

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Phthalates in 5-Aminosalicylates: Informing Therapeutic Choice and Minimizing Risk

Publication of THE LATEST IN ULCERATIVE COLITIS CARE supplement was made possible by an unrestricted educational grant from Aptalis Pharma

Geoffrey C. Nguyen, MD, PhD,

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Abstract: 5-Aminosalicylates (5-ASAs) are considered first-line therapy for mild to moderate ulcerative colitis because of their proven effectiveness and safety profile, even in pregnancy. One formulation, however, contains dibutyl phthalate (DBP) in its coating. Though DBP may cause disruptions in utero reproductive development and other congenital abnormalities in rodents, it is unclear whether it leads to physiologically significant fetal abnormalities in humans. The US Food and Drug Administration has changed its classification for DBP-containing 5-ASAs from pregnancy category B to pregnancy category C to reflect a greater degree of uncertainty regarding its effect in humans. For pregnant women with ulcerative colitis, the most important message is to take their inflammatory bowel disease (IBD) medications to prevent disease relapse, which may have the most adverse effects on pregnancy. Physicians should, however, discuss with young women who are taking 5-ASA with DBP the benefits and risks of switching to another formulation of 5-ASA without the DBP compound.

Key Words: phthalates, 5-aminosalicylate, ulcerative colitis, dibutyl phthalate, pregnancy.

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5-Aminosalicylates (5-ASAs) are effective for the treatment of mild to moderate ulcerative colitis and are generally regarded as safe to use, even during pregnancy.

Dibutyl phthalate (DBP) is found in the coating of certain formulations of 5-ASA, and in rodents has been shown to be associated with developmental and congenital abnormalities.

Though phthalates have been shown to be associated with some indicators of reduced masculinization among male fetuses, there is insufficient evidence to prove that it leads to significant harmful effects.

There are several formulations of 5-ASA that do not contain DBP.

Asacol, which contains DBP, is categorized as a pregnancy category C drug, while most other 5-ASAs are in pregnancy category B.

It should be emphasized to pregnant women that taking medications for their inflammatory bowel disease is important because the disease has a strong impact on, not just their health, but the health of their fetus too.

Women of child-bearing age who are taking a DBP-containing 5-ASA should have a discussion regarding the benefits and risks of switching to another 5-ASA, preferably before pregnancy.

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Ulcerative Colitis: A Case Study

Publication of THE LATEST IN ULCERATIVE COLITIS CARE supplement was made possible by an unrestricted educational grant from Aptalis Pharma

Brian Bressler, MD, MS, FRCPC,

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Abstract: A 28-year-old male presented to our office for a consultation about his bloody bowel movements. Colonoscopy revealed moderately active left-sided ulcerative colitis extending from the anal verge up to the mid-descending colon. He was prescribed both oral and rectal 5-ASAs for induction therapy, and is in remission. Appropriate patient education has helped him realize that the best chance of staying in remission is to continue on his medical therapy.

Key Words: ulcerative colitis, 5-aminosalicylate, medication adherence, dysplasia surveillance, rectal inflammation.

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Stool samples should be tested for infectious causes of bloody diarrhea.

Treatment with steroids should be avoided, if possible, as this medication carries the most risk.

In most cases, clinical remission is an acceptable outcome.

In patients newly diagnosed with left-sided ulcerative colitis, if macroscopic evidence of inflammation stops before 35 cm from the anal verge, it is critical to take biopsies in the proximal left colon in normal-appearing mucosa to determine whether a patient with left-sided disease will require dysplasia surveillance.

Patient education at each follow-up visit helps to ensure medication adherence.

We need to help patients understand that UC can be managed with medication, but not cured.

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Optimizing Targets in Patient Management of Ulcerative Colitis: The Role of Fecal Calprotectin in Guiding Maintenance Therapy

Publication of THE LATEST IN ULCERATIVE COLITIS CARE supplement was made possible by an unrestricted educational grant from Aptalis Pharma

A. Hillary Steinhart, MD,

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Abstract: Although medical therapy for ulcerative colitis is usually effective at inducing clinical remission, numerous studies have shown that patients in clinical remission may have ongoing and varying degrees of mucosal inflammation. It appears that patients who have greater degrees of active mucosal inflammation, despite the absence of clinical symptoms, are at higher risk of developing a symptomatic flare in the near term. In patients with UC, the level of calprotectin in stool correlates not only with the degree of clinical severity but also with the presence or absence of mucosal inflammation. These findings raise the possibility of using fecal calprotectin as a non-invasive means of monitoring patients in clinical remission and adjusting treatment in those who demonstrate a rise in fecal calprotectin, before symptoms recur.

Key Words: ulcerative colitis, fecal calprotectin, flare prediction, mucosal inflammation, non-invasive monitoring.

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Patients who experience a symptomatic flare after having been in clinical remission often have increased mucosal inflammation that predates the flare—sometimes by several months.

With the importance of mucosal healing acknowledged, there has been increasing interest in more frequent assessment of mucosal healing and mucosal inflammation.

This has led to the examination of a number of non-invasive and less expensive means of assessing these parameters.

The presumption is that if such risk factors can be identified, then effective interventions can be applied earlier in the course of disease in order to prevent a clinical flare.

In patients with UC, the level of fecal calprotectin correlates not only with the degree of clinical severity but also with the presence of absence of mucosal inflammation.

These findings raise the possibility of using fecal calprotectin as a non-invasive means of monitoring patients in clinical remission, and adjusting treatment in those who demonstrate a rise in fecal calprotectin, before symptoms recur.

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Soins complets aux patients dans le cadre du traitement de la colite ulcéreuse

Marc Bradette, M.D., FRCPC, CSPQ, professeur clinicien, département de gastroentérologie, Pavillon Hôtel-Dieu de Québec, Québec (Québec).

Related Terms: Gastrointestinal Diseases, ulcerative colitis

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Optimiser les objectifs lors de la prise en charge des patients atteints de colite ulcéreuse : Rôle de la calprotectine fécale pour orienter la thérapie d'entretien

A. Hillary Steinhart, M.D., est membre du service de gastroentérologie du Mount Sinai Hospital/University Health Network, et est professeur de médecine à l'Université de Toronto à Toronto (Ontario).

Résumé
Bien qu'une thérapie d'entretien pour la colite ulcéreuse permette généralement d'obtenir une rémission clinique, de nombreuses études ont montré que les patients en rémission clinique pourraient présenter des degrés variables d'inflammation de la muqueuse. Il semble que les patients présentant le plus haut degré d'inflammation évolutive de la muqueuse, malgré l'absence de symptômes cliniques, sont plus susceptibles de subir une poussée symptomatique à court terme. Chez les patients atteints de CU, le taux de calprotectine dans les selles est associé non seulement à la présence ou l'absence d'inflammation de la muqueuse, mais également au degré de gravité clinique de la CU. Ces observations soulèvent la possibilité d'utiliser le taux de calprotectine fécale pour surveiller de manière non effractive les patients en rémission clinique, et modifier le traitement de ceux montrant une augmentation du taux de calprotectine fécale, et ce, avant la réapparition des symptômes.
Mots clés : colite ulcéreuse, calprotectine fécale, prédiction des poussées, inflammation de la muqueuse, surveillance non effractive.