Inflammatory Bowel Disease

Ulcerative Colitis: 
Inflammation and ulcers restricted to colon and rectum 

Sypmtoms 
  • Diarrhoea (may contain pus or mucus)
  • Abdominal pain
  • Some may experience flare up and these symptoms include:
    -Painful and swollen joints (arthritis
      mouth ulcers
    -Swollen fat under the skin causing bumps and patches – this is known as erythema nodosum
    -Irritated and red eyes
    -Weight-loss
    -Fatigue
    -Problems with bones, such as osteoporosis

Diarrhoea associated with ulcerative colitis is sometimes treated with anti-diarrhoeal drugs (such as loperamide hydrochloride or codeine phosphate) on the advice of a specialist

Contraindicated in acute UC flare ups: Loperamide hydrochloride and codeine phosphate as this increases the risk of toxic megacolon.

Longterm Problems
  • An increased risk of developing bowel cancer  
  • Poor growth and development in children and young people
  •  Osteoporosis- because of using steroid medicines treat ulcerative colitis
  • Toxic megacolon
  • Venous Thromboembolism



Treatment is based on the severity and which part of the colon is affected

Mild to Moderate

Proctitis:

Topical Aminosalicylate recommended as first-line.

Remission not achieved in 4 weeks: Add oral aminosalicylate

Remission still not achieved:
Topical or oral corticosteroid can be added for 4-8 weeks.

Proctosigmoiditis and Left Sided Colitis

Topical aminosalicylate as first-line treatment.

Remission not achieved in 4 weeks: Add or switch to high-dose oral aminosalicylate and 4 to 8 weeks of a topical corticosteroid.

Remission still not achieved:
Stop topical treatment and offer an oral aminosalicylate + 4 to 8 weeks of an oral corticosteroid.

Extensive Colitis 

Topical aminosalicylate + high-dose oral aminosalicylate recommended as first-line treatment

Remission still not achieved in 4 weeks: Stop topical treatment and offer a high dose oral aminosalicylate + 4 to 8 weeks of an oral corticosteroid.

Moderate to Severe

Oral prednisolone • 

Monoclonal antibody’s

TNF-a inhibitors

Severe

First line: IV croticosteroids (hydrocortisone or methylprednisolone)+ assess need for surgery

Alternative IV ciclosporin (Unlicenced)

Second Line: IV ciclosporin + IV corticosteroids or surgery if patient not improved within 72 hours

Infliximab if IV ciclosporin contraindicated

Maintaining Remission 

Aminisalicylate recommended

Corticosteroids are not suitable for maintenance treatment because of their side-effects. 

Proctitis or Proctosigmoiditis:

Rectal aminosalicylate can be started alone or in combination with an oral aminosalicylate, administered daily or as part of an intermittent regimen (such as twice to three times weekly or the first seven days of each month).

Left-sided or extensive ulcerative colitis

Low-dose of oral aminosalicylate