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Clin Colon Rectal Surg 2010; 23(4): 227-238
DOI: 10.1055/s-0030-1268249
© Thieme Medical Publishers

Pros and Cons of Medical Management of Ulcerative Colitis

Udayakumar Navaneethan1 , Bo Shen1
  • 1Center for Inflammatory Bowel Disease, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
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Publication History

Publication Date:
07 December 2010 (online)

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ABSTRACT

Ulcerative colitis (UC) is a chronic inflammatory disease characterized by diffuse mucosal inflammation limited to the colon and rectum. Although a complete medical cure may not be possible, UC can be treated with medications that induce and maintain remission. The medical management of this disease continues to evolve with a goal to avoid colectomy and ultimately alter the natural history of UC. Emergence of antitumor necrosis factor-α (TNF-α) agents has expanded the medical armamentarium. 5-Aminosalicylates continue to be used in mild to moderate UC and corticosteroids are mainly used for induction of remission with immunomodulators (6-mercaptopurine/azathiopurine/methotrexate) being applied as steroid-sparing agents for maintenance therapy. Infliximab has been approved by the U.S. Food and Drug Administration and used in the treatment of moderate to severe UC; nevertheless, its use may be associated with significant adverse effects and have a negative impact on the postoperative course should the patients undergo restorative proctocolectomy. In addition, there is always a concern about patients' compliance to medical therapy, cost of medications, and risk for UC-associated dysplasia. The authors discuss the pros and cons of medications used in the treatment of UC.

KEYWORDS

Inflammatory bowel disease - ulcerative colitis - medical treatment - risks and benefits

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Bo ShenM.D. 

Digestive Disease Institute, Desk A31

Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195

Email: shenb@ccf.org