Update in Medical Therapy of Ulcerative Colitis
Update in Medical Therapy of Ulcerative Colitis
US Gastroenterology & Hepatology Review Volume 4 Issue 2
Published: October 2009
Published: October 2009
The bewildering array of medications available in the therapy of ulcerative colitis (UC), with agents of differing efficacy and safety, often confuses the clinician. A reasonable approach to this daunting problem divides the disease into categories of mild, moderate, severe, and fulminant with suggested therapeutic guidelines from the American College of Gastroenterology (ACG)1 (see Table 1) and the European Crohn’s and Colitis Organization (ECCO). This advice is based on a balance of literature reviews, grading of quality of evidence, and consensus of experts.2,3
Mild to Moderate Ulcerative Colitis
5-aminosalicylic acid (5-ASA) has been extensively evaluated and is considered the first-line therapy for mild to moderate UC.5,6 Considering that this category encompasses 91% of UC patients in a community practice,7 it is worthwhile understanding 5-ASA’s putative mechanisms of action, efficacy, and safety features. The presumed anti-inflammatory processes include targeting peroxisome proliferator-activated receptor gamma (PPAR-γ),8,9 which is involved in the control of inflammation, cell proliferation, apoptosis, and a varietyof metabolic functions. Other mechanisms of action include inhibition of prostaglandin synthesis by inhibiting cyclo-oxygenase,10 interleukin (IL)-1 synthesis,11–13 nuclear factor kappa B (NF-ΚB) activation by tumor necrosis factor-alpha (TNFα),14 and by scavenging oxygen-free radicals.15
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Keywords:
Ulcerative Colitis, American College of Gastroenterology, ACG,
Ulcerative Colitis, American College of Gastroenterology, ACG,
