| Theme |
Up-to-date Treatment for Inflammatory Bowel Diseases |
| Title |
Update on Medical Therapy for Ulcerative Colitis |
| Author |
Kazufumi Yamagata |
Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine |
| Author |
Yoh Ishiguro |
Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine / Department of Endoscopy, Hirosaki University School of Medicine & Hospital |
| Author |
Yuki Satoh |
Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine |
| Author |
Shinsaku Fukuda |
Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine |
| Author |
Akihiro Munakata |
Professor emeritus, Hirosaki University |
| [ Summary ] |
Progress on ulcerative colitis (UC) management strategies in Japan is reviewed. A recommendation was made by the consensus of experts. This recommendation was approved by a board of the Research Committee of Inflammatory Bowel Disease implemented by the Japanese Ministry of Health, Labor, and Welfare.
The efficacy of aminosalicylates for induction of remission in mild to moderate UC is well established, as has been their role in the maintenance of remission of UC. Although steroid therapies have been shown to be highly effective in short term treatment of active UC, their value in maintenance therapy has never been shown. The definition of refractory UC continues to evolve as therapeutic options and efficacy improve. In concert with the concepts of induction of remission and maintenance of remission. it is useful to examine refractoriness from the perspectives of failure to induce improvement (steroid resistance), and failure to maintain remission (steroid dependence). Other agents effective in inducing or maintaining remission are 6-mercaptopurine (6-MP) / azathioprine, cyclosporine (CyA), and leuhocytapheresis. Most of the uncontrolled as well as controlled studies have revealed the long term efficacy of 6-MP and azathioprine (AZA) in maintenance therapy for IBD, over 2 to 5 year periods. In steroid dependent UC, 6-MP and AZA were effective and may have steroid sparing effects. For steroid refractory cases, leuhocytapheresis, or CyA combined 6-MP and AZA were well established therapies for induction and maintainance of states of remission. Topical therapy with steroids and / or aminosalicylates should be indicated for proctitis treatment. Currently, a broad range of option allows physicians to tailor treatment to individual patient needs and preferences. |