Description
Ulcerative colitis is diagnosed through a combination of clinical evaluation, laboratory tests, imaging studies, and endoscopic examination of the colon. Key diagnostic tests include stool studies to rule out infections, blood tests for inflammatory markers like C-reactive protein and fecal calprotectin, and colonoscopy with biopsy to visualize the colon and confirm the diagnosis. Imaging studies like CT scans or MRI may be used to assess disease severity and complications such as toxic megacolon or perforation. Management of ulcerative colitis involves a step-wise approach, starting with anti-inflammatory medications like aminosalicylates for mild to moderate disease.Immunosuppressants such as corticosteroids, thiopurines, or biologics (e.g., anti-TNF agents) are used for moderate to severe disease or if patients do not respond to first-line therapy. Regular monitoring of disease activity through symptom assessment, blood tests, and endoscopic evaluation is crucial for disease management and to prevent complications.
Résumé
- Inflammatory bowel diseases (IBD) are autoimmune disorders affecting the gut, primarily categorized into ulcerative colitis (UC), Crohn's disease, and indeterminate colitis. The pathophysiology involves genetic predisposition, environmental factors, and altered gut microbiota, leading to immune dysregulation and intestinal ulceration. Westernized diets, rich in processed foods, saturated fats, and sugars, increase IBD risk.
- Diagnosis of UC is multifaceted, relying on clinical assessment, laboratory tests, imaging, endoscopy, and histopathology. There is no single "gold standard" test. Infectious causes must be ruled out. Montreal classification categorizes the extent of disease (E1, E2, E3) based on colonoscopic findings. Histological features include crypt architectural distortion and basal plasmacytosis.
- Severity of UC is assessed using Truelove and Witts criteria and the Mayo score, which considers stool frequency, rectal bleeding, endoscopy findings, and physician's global assessment. Imaging is reserved for severe cases to rule out toxic megacolon or perforation. Fecal calprotectin levels can monitor disease activity non-invasively. Differentiation from Crohn's disease is vital for treatment decisions.
- Treatment of UC follows a sequential therapy approach, starting with aminosalicylates for mild disease. Mesalamine is a commonly used aminosalicylate available in oral and rectal formulations. Budesonide MMX is an alternative with fewer systemic side effects than systemic steroids. Azathioprine and mercaptopurine are thiopurines used as immunosuppressants.
- For those unresponsive to initial treatments, anti-TNF agents (infliximab, adalimumab) or other biologics targeting cytokines (ustekinumab) are considered. Tofacitinib, a JAK inhibitor, is an oral option. Vedolizumab targets integrins, preventing lymphocyte migration. Ozanimod, a sphingosine-1-phosphate receptor modulator, is under investigation. Vaccination against hepatitis A and B, pneumococcus, and influenza is recommended.
- Surgery, involving total colectomy and ileal pouch-anal anastomosis (IPAA), is an option for severe cases unresponsive to medical management. Acute severe ulcerative colitis is a medical emergency diagnosed using Truelove and Witts criteria. Treatment involves IV steroids and antibiotics, avoiding antimotility drugs and NSAIDs. Patients are monitored for response using Oxford criteria, with rescue therapy (surgery, biologics, cyclosporine, tofacitinib) for non-responders. Colonoscopic surveillance is essential due to increased risk of colorectal cancer.
Exemple de certificat
À propos des intervenants
Dr. Gopi Srikanth
Consultant Gastroenterologist, Yashoda Hospitals, Hyderabad
Divulgation financière
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