Ulcerative Colitis
Ulcerative colitis (UC) is a chronic inflammatory disease of unknown cause, which typically affects the rectum and variable areas of the proximal colon in a continuous pattern. There is no known cure but medications are often effective in controlling the inflammation and the associated symptoms. Based on the location and extent of the inflammation, the clinician can determine which medications may be expected to provide symptomatic benefit with a minimum of adverse effects. Hence, knowledge of the disease extent and severity of activity are critical to planning a medical therapy program.
When patients present with active symptoms, the primary
initial goal is to alleviate the symptoms and induce remission.
The secondary goal is to plan for a treatment program to
maintain long-term remission. These two phases of treatment
may require a series of medications using different doses and
routes of delivery, with a transition from induction of remission
to maintenance of remission after the first few weeks.
Ideally, any medical therapy should be evidence based
(see Chapter 1,“Using Evidence-Based Medicine in Patient
Care”). However most therapeutic trials, including those
for UC, involve a single drug given at fixed dose for a short
period of time and the trials do not address the changing
needs of the patient over time, through the spectrum of
changes in disease activity and extent. In reality, the best
therapy for an individual patient with UC is based in part
on evidence-based data and in part on anecdotal clinical
experience. Depending on the unique circumstances for an
individual patient, treatment of UC with either a sequential
or combination therapeutic approach can be effective.