IBD Treatment: Ulcerative Colitis

Question 1

Severity levels of UC

Answer 1

Remission, mild, moderate-severe, fulminant

Question 2

Characteristics of remission in UC

Answer 2

Formed stools
No blood
Normal hemoglobin, ESR, and CRP
FC is <150-200

Question 3

Characteristics of mild UC

Answer 3

<4 stools/day
Intermittent blood in stools
Normal hemoglobin and ESR
Elevated CRP
FC >150

Question 4

Characteristics of moderate-severe UC

Answer 4

<6 stools/day
Frequent blood in stools
Hemoglobin is <75% normal
ESR and CRP are elevated
FC >150

Question 5

Characteristics of fulminant UC

Answer 5

>10 stools/day
Continuous blood in stools
Requires blood transfusions due to low hemoglobin (<8)
ESR and CRP are elevated
FC >150

Question 6

Active therapy for mild-distal UC

Answer 6

First line: topical 5-ASA (mesalamine) preps PR
Second line: PO 5-ASA
Can try combo of PR and PO therapies

Question 7

Active therapy for refractory mild-distal UC

Answer 7

Uceris (budesonide)

Question 8

Extensive active therapy for mild-distal UC

Answer 8

PO 5-ASA is first line

Can consider adding Uceris for 8 weeks

Question 9

Active therapy for moderate-severe UC

Answer 9

Uceris
PO prednisone
Infliximab +/- 6-MP/AZA

Question 10

Active therapy for fulminant UC

Answer 10

IV steroids (hydrocortisone, methylprednisolone)
Infliximab (use when IV steroids fail or during first-time treatment)
IV cyclosporine
Colectomy

Question 11

Maintenance therapy for mild-distal UC

Answer 11

Topical or PO 5-ASA

Question 12

Maintenance therapy for mild extensive UC

Answer 12

PO 5-ASA, but can combine PO and PR treatment

Question 13

Maintenance therapy for moderate-severe and fulminant UC is dependent on what?

Answer 13

What the patient improved on

Question 14

If the patient improves with a steroid, what is the maintenance therapy for moderate-severe/fulminant UC?

Answer 14

6-MP derivative (azathioprine)

Question 15

How long will it take for azathioprine to take effect?

Answer 15

~4 months, start at the beginning of steroid use

Question 16

If the patient improves with a biologic, what is the maintenance therapy for moderate-severe/fulminant UC?

Answer 16

Continue with the same biologic and use 6-MP or azathioprine

Question 17

If the patient improves with IV cyclosporine, what is the maintenance therapy for moderate-severe/fulminant UC?

Answer 17

Use 6-MP/azathioprine or vedolizumab

Question 18

What drug should you not use in moderate-severe/fulminant maintenance therapy for UC?

Answer 18

5-ASA!