Skip to main content

Main menu

  • Home
  • Articles
    • Current
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About CFP Mainpro+
    • Member Login
    • Instructions
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums

User menu

  • My alerts

Search

  • Advanced search
The College of Family Physicians of Canada
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums
  • My alerts
The College of Family Physicians of Canada

Advanced Search

  • Home
  • Articles
    • Current
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About CFP Mainpro+
    • Member Login
    • Instructions
  • RSS feeds
  • Follow cfp Template on Twitter
Research ArticlePractice

Navigating the complexity of ulcerative colitis

Challenging case example

Mark Lees, Loren Regier and Brent Jensen
Canadian Family Physician May 2011, 57 (5) 568-572;
Mark Lees
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Loren Regier
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: regierl@rxfiles.ca
Brent Jensen
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • CFPlus
  • eLetters
  • Info & Metrics
  • PDF
Loading

Article Figures & Data

Tables

  • Additional Files
    • View popup
    Table 1

    Overview of common drugs for the treatment of UC

    DRUGTIME TO EFFECTROLECOMMENTS
    SSZ Salazopyrin2–4 wkAcute and maintenance therapy for UCDose-related side effects; less expensive than 5-ASA
    5-ASA (mesalamine)
      Asacol
      Pentasa
      Mesasal
      Salofalk
    2–4 wkAcute (higher doses) and maintenance therapy (lower doses) for UC1Often better tolerated than SSZ
    All oral formulations are active in rectum and proximal and distal colon; some products are also active higher in the gastrointestinal tract. Foam, enema, and rectal suppository formulations are useful for distal or rectal disease. Effective reach of effect:
    • suppository: 10 cm

    • foam: 15–20 cm

    • enemas: splenic flexure2


    Foam might be preferred for patients who have difficulty retaining enemas
    Corticosteroids
      Prednisone, oral Budesonide (Entocort)
      Hydrocortisone (Cortifoam, Hycort, Cortenema)
      Hydrocortisone, IV (Solu-Cortef)
      Methylprednisolone, IV (Solu-Medrol)
    < 7–14 dAcute exacerbations of UC when severe or unresponsive to 5-ASA or SSZHigher initial doses required until clinical improvement is seen, then taper gradually and discontinue; other maintenance agents safer for maintenance of remission
    Oral or IV administration; IV administration useful in more severe or fulminant disease
    Anti-inflammatory dose equivalency: prednisone
    5 mg = methylprednisolone 4 mg = hydrocortisone 20 mg Topical enemas and foams useful for distal colon and rectal disease
    Budesonide less bioavailable than prednisone; less effective, fewer side effects, more expensive
    Purine antimetabolites
      AZA (Imuran)
      6MP (Purinethol)
    3–6 moModerate to severe UC, for patients not responding to corticosteroids and for those unable to adequately wean from corticosteroids (eg, steroid sparing)Maintenance doses are the same as induction doses Requires monitoring of CBC, LFTs, and for symptoms of pancreatitis
    Methotrexate lacks evidence in UC but can be tried if AZA is ineffective or not tolerated3
    Biologic response modifiers (TNFα inhibitors)
      Infliximab (Remicade)
      Adalimumab (Humira)
    Within 2 wkAcute and maintenance therapy for UC in moderate to severe disease that is not responsive to standard treatment; avoid in active infection, acute heart failure, or hypersensitivityVery effective in some, but also considerable potential harms, including increased risk of infection (eg, viral [especially varicella], fungal, or bacterial and reactivation of tuberculosis or hepatitis B), infusion reactions (especially with infliximab),4 and rare lymphoma or drug-induced lupus. Recent meta-analysis found that in the short term, biologics had a higher rate of total adverse reactions vs control (NNH = 30, 95% CI 21–60), but the rate of serious adverse events was not different.5 Long-term research is lacking
    Cyclosporine2–3 wkEffective as surgery-sparing agent in acute, severe, steroid-refractory UC; useful as interim therapy while waiting for effect of purine antimetaboliteRarely used with availability of the biologics
    Probiotic VSL#3NAMaintenance therapy of mild to moderate UCLimited evidence suggests benefit in maintenance therapy of mild to moderate UC6
    • 5-ASA—5-aminosalicylic acid, 6MP—mercaptopurine, AZA—azathioprine, CBC—complete blood count, CI—confidence interval, IV—intravenous, LFT—liver function test, NNH—number needed to harm, SSZ—sulfasalazine, TNF—tumour necrosis factor, UC—ulcerative colitis.

    • Adapted from Sutherland and MacDonald.7

Additional Files

  • Tables
  • CFPlus Additional Information

    This data supplement contains an Inflammatory Bowel Disease chart.

    Files in this Data Supplement:

    • Adobe PDF - IBD_chart.pdf
PreviousNext
Back to top

In this issue

Canadian Family Physician: 57 (5)
Canadian Family Physician
Vol. 57, Issue 5
1 May 2011
  • Table of Contents
  • About the Cover
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on The College of Family Physicians of Canada.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Navigating the complexity of ulcerative colitis
(Your Name) has sent you a message from The College of Family Physicians of Canada
(Your Name) thought you would like to see the The College of Family Physicians of Canada web site.
Citation Tools
Navigating the complexity of ulcerative colitis
Mark Lees, Loren Regier, Brent Jensen
Canadian Family Physician May 2011, 57 (5) 568-572;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Respond to this article
Share
Navigating the complexity of ulcerative colitis
Mark Lees, Loren Regier, Brent Jensen
Canadian Family Physician May 2011, 57 (5) 568-572;
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Diagnosis …
    • First remission …
    • Bringing evidence to practice
    • Difficult year …
    • Bringing evidence to practice
    • Another admission and another medication …
    • Bringing evidence to practice
    • Serious complication …
    • Footnotes
    • References
  • Figures & Data
  • CFPlus
  • Info & Metrics
  • eLetters
  • PDF

Related Articles

  • Scopus
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

Practice

  • Palliative care in patients with severe mental illness
  • Quick and painless
  • Navigating cannabinoid choices for chronic neuropathic pain in older adults
Show more Practice

RxFiles

  • Explorer les choix de cannabinoïdes pour la douleur neuropathique chronique chez les adultes plus âgés
  • Navigating cannabinoid choices for chronic neuropathic pain in older adults
  • Tapering opioids using motivational interviewing
Show more RxFiles

Similar Articles

Navigate

  • Home
  • Current Issue
  • Archive
  • Collections - English
  • Collections - Française

For Authors

  • Authors and Reviewers
  • Submit a Manuscript
  • Permissions
  • Terms of Use

General Information

  • About CFP
  • About the CFPC
  • Advertisers
  • Careers & Locums
  • Editorial Advisory Board
  • Subscribers

Journal Services

  • Email Alerts
  • Twitter
  • RSS Feeds

Copyright © 2019 by The College of Family Physicians of Canada

Powered by HighWire